Case report on VMAT radiotherapy for inoperable anal Buschke-Lowenstein tumors

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Frontiers in Medicine Published May 22, 2026 Medically reviewed May 22, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider VMAT radiotherapy as a feasible, safe option for selected patients with inoperable anal Buschke-Lowenstein tumors.

This is a case report with an accompanying literature review focused on inoperable anal Buschke-Lowenstein tumors. The authors describe two patients treated with definitive radiotherapy using volumetric-modulated arc therapy (VMAT). One patient received concurrent chemoradiotherapy (30 Gy in 15 fractions) and had a marked clinical response with grade 2 acute radiomucositis. The other patient underwent radiotherapy alone (45 Gy in 25 fractions) and had a partial clinical response with minimal toxicity. Both treatments were well tolerated.

The literature review component notes that evidence for radiotherapy as a primary treatment for this condition is limited and that treatment approaches in the literature are heterogeneous. The authors conclude that radiotherapy using contemporary VMAT techniques is feasible, safe, and effective for selected patients with inoperable BLTs.

Key limitations acknowledged include the very small sample size of two cases and the limited evidence base. The authors caution against inferring causality from case reports and against generalizing findings beyond these two cases and the literature review. Practice relevance is restrained, supporting consideration of radiotherapy within a multidisciplinary management framework for this rare condition.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

BackgroundBuschke–Löwenstein tumors (BLTs), also known as giant condyloma acuminatum, are rare HPV-related lesions with benign histology but locally aggressive behavior, high recurrence rates, and risk of malignant transformation. Complete surgical excision is the standard treatment; however, surgery may be infeasible in advanced, recurrent, or anatomically complex cases. Evidence for radiotherapy as a primary treatment is limited.Case presentationWe report two patients with inoperable anal BLTs treated using modern volumetric-modulated arc therapy (VMAT). Patient 1 received concurrent chemoradiotherapy (30 Gy in 15 fractions) and achieved a marked clinical response with grade 2 acute radiomucositis. Patient 2 underwent definitive radiotherapy alone (45 Gy in 25 fractions) resulting in a partial clinical response at early follow-up, with minimal toxicity. Both treatments were well tolerated. We performed a literature review of published cases of BLTs treated with radiotherapy between 2000 and 2025, which demonstrated heterogeneous treatment approaches but generally favorable clinical responses and acceptable toxicity.ConclusionsRadiotherapy using contemporary VMAT techniques is feasible, safe, and effective for selected patients with inoperable BLTs. When surgery is not possible, radiotherapy alone or combined with chemotherapy may provide early clinical tumor regression with limited toxicity. These findings, combined with existing literature, support consideration of radiotherapy in multidisciplinary management of this rare condition.