Abstract
PurposeThe aim of this study is to determine overall survival, disease-specific survival and stoma-free survival after treatment of squamous cell carcinoma of the anus with chemoradiotherapy followed by brachytherapy or electron boost in a recent cohort of patients.MethodsFifty-two patients (median age 62 years) were treated with radical chemoradiotherapy (mitomycin C, infusional 5-fluorouracil concurrently with conformal radical radiotherapy 45 Gy in 25 fractions over 5 weeks) followed by a radiotherapy boost between 1 December 2000 and 30 April 2011. Follow-up was to 30 November 2014. Thirty-six patients received a boost (15–20 Gy) over 2 days with 192Ir needle brachytherapy for anal canal tumours, and 16 patients received electron beam therapy (20 Gy in 10 fractions in 2 weeks) for anal margin tumours. A defunctioning stoma was only created prior to chemoradiotherapy for fistula or severe anal pain.ResultsThe overall survival for the 36 patients treated with chemoradiotherapy followed by brachytherapy was 75 % (95 % CI, 61–89) at 5 years, the disease-specific survival was 91 % (95 % CI, 81–101 %), and the stoma-free survival was 97 % (95 % CI, 91–103 %) all at 5 years. For the 16 patients treated with an electron boost for anal margin tumours, the 5-year overall survival, disease-specific survival and stoma-free survival were 68 % (95 % CI, 44–92 %), 78 % (95 % CI, 56–100 %) and 80 % (95 % CI, 60–100 %), respectively.ConclusionsA very low stoma formation rate can be obtained with radical chemoradiotherapy followed by a brachytherapy boost for squamous cell carcinoma of the anal canal but not with an electron boost for anal margin tumours.
Highlights
Squamous cell carcinoma (SCC) of the anus is caused predominantly (84 %) by human papilloma virus (HPV 16) in comparison to cervical carcinoma (70 %) (HPV 16 and 18) and oropharyngeal carcinoma (33 %) (HPV 16) [1]
A very low stoma formation rate can be obtained with radical chemoradiotherapy followed by a brachytherapy boost for squamous cell carcinoma of the anal canal but not with an electron boost for anal margin tumours
In contrast to the high doses of radical radiotherapy (65–70 Gy) used in the chemoradiotherapy of cervical carcinoma and oropharyngeal carcinoma, recent trials in the UK ACT II trial [2] have established that doses of 50.4 Gy in 28 daily fractions combined with mitomycin C and 5-fluorouracil give a 3-year progression-free survival of 80 % for T1 or T2 disease but 65 % for T3 or T4 disease
Summary
Squamous cell carcinoma (SCC) of the anus is caused predominantly (84 %) by human papilloma virus (HPV 16) in comparison to cervical carcinoma (70 %) (HPV 16 and 18) and oropharyngeal carcinoma (33 %) (HPV 16) [1]. In contrast to the high doses of radical radiotherapy (65–70 Gy) used in the chemoradiotherapy of cervical carcinoma and oropharyngeal carcinoma, recent trials in the UK ACT II trial [2] have established that doses of 50.4 Gy in 28 daily fractions combined with mitomycin C and 5-fluorouracil give a 3-year progression-free survival of 80 % for T1 or T2 disease but 65 % for T3 or T4 disease. In the RTOG 98-11 trial [3] published in 2008, in which a radiotherapy boost of 10–14 Gy in 2 Gy fractions was given for locally advanced disease (total 55–59 Gy), the 5-year colostomy-free survival was 90 % in the Mitomycin-based group. The results of chemoradiotherapy with brachytherapy or electron therapy boost in Nottingham, UK (2000–2011), for locally advanced SCC of the anus were analysed to determine overall survival, disease-specific
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