568 Combined chemoradiation for anal cancer: Report of 22 cases

Abstract

From 1988 to 1994 22 patients (pts) with anal cancer, 16 females and 6 males, were treated with concurent CT and RT as definitive therapy. Median age was 64 years (range 39–91). Hystotype was squamous carcinoma in 19 and cloacogenic carcinoma in 3 pts. Distribution per stage was: II 12, IlIA 3, IIIB 3; 4/22 cases were treated after surgical relapse (3 local, 1 inguinal nodal). CT and RT started the same day. CT, modified from the schedule of Nigro, was: 5-FU 1000 mg/m²/day for 5 days by continuous, Mitomycin 10–15 mg/m² day 1, every 4 weeks. In 11/22 pts 5-FU was administered via a portable infusion pump. RT was delivered 1.8 GY/day<i>,</i> 5 fractions/week, with a 6 MeV linear accelerator. A median dose of 45 Gy (40–50 Gy) was delivered on the anoperineal volume and the middle and lower pelvis, including bilateral inguinal and external iliac nodes, by opposite anteroposterior portals; after a median split of 10 days, a boost dose was given to the anoperineal region with a direct field by an electron beam of 9–16 MeV, up to a median total dose of 56 Gy (51–63 Gy). The same boost was given to metastatic inguinal nodes. Nineteen pts completed the treatment and are evaluable for response and toxicity; 3 are still on therapy. Fourteen out of 19 pts received two cycles of CT, 5/19 three or more cycles. Pathologic response was documented in all the pts; pCR was achieved in 100% of cases. With a median follow-up of 19 months (range 5–78), 17/19 pts (89.5%) are free from relapse with mantained anorectal function. Two pts (10.5%) relapsed locally, after 8 and 11 months respectively; in one case abdominoperineal resection was performed as salvage therapy, and the pt is now alive NED; the other pt is receiving further CT. Eleven pts (58%) had G3-WHO dermatitis; G3–4 sistemic toxicity was uncommon: 2 thrombocytopenia, 1 neutropenia, 1 stomatitis. One pt had an impairment of a previous known angina pectoris. Late toxicity occurred until now in 2 pts, with a vaginal stenosis and a rectal stenosis. No difference in toxicity was observed in pts receiving 5-FU by pump. The treatment was administered, with a 20% reduction of doses of chemotheraphy, also to elderly pts (4 pts were ≥75 years), with good tolerance. Although the period of follow-up is short, our study confirms that concurrent CT-RT is the standard treatment for anal cancer, with relevant but acceptable toxicity; the treatment is feasible and safe also in elderly pts.