5-year survival following radiotherapy in anal cancer audit in a single center.

Abstract

e15070 Background: Anal cancer accounts for 1% of new cancer diagnoses. Incidence rates are increasing and predicted to rise. Randomised controlled trials have demonstrated superior outcomes with chemoradiation, the standard of care. The recommended dose for two phases is 50.4Gray in 28 fractions, with 5- fluorouracil (5-FU) and mitomycin C as per the UKCCCR ACT I trial. The addition of chemotherapy has been shown to improve outcomes, however is contraindicated in certain cases. Retrospective audit is important to ensure effectiveness of chemoradiation for anal cancer. Methods: Patients were identified retrospectively in a single centre, who had undergone radiotherapy for anal cancer between 2008 and 2013. The only histological subtype included was squamous cell carcinoma. Patients were included who received radiotherapy alone and concomitant chemotherapy. All TNM stages were included and patients treated with palliative intent at the outset were included. Available imaging was reviewed and staging updated in line with TNM 8th edition. 5 year survival was primarily evaluated. The proportion of patients who had a defunctioning stoma and subsequent reversal was investigated. Results: 55 patients were included in the analysis. The overall 5 year survival was 75% and 5 year relapse free survival 87%. 45 patients received chemoradiotherapy and 38 (84%) of this group received mitomycin C and 5-FU regimen. 7 (13%) patients relapsed, 3 (43%) of which were local. All of these patients proceeded to an abdomino-perineal resection. The commonest fractionation schedule used was 50.4 Gray in 28 fractions. The median stage at presentation of this cohort was T2 N0 M0. The mean age at diagnosis 61.4 years. 1 patient died whilst receiving treatment. 13 (24%) patients had a defunctioning stoma prior to radiation treatment. 3 (23%) had a subsequent reversal of the stoma. Conclusions: Chemoradiotherapy is an effective treatment for squamous cell carcinomas of the anal canal, with good relapse free survival. When a defunctioning stoma is performed prior to chemoradiation there is a low rate of reversal.