Faut-il adapter le traitement du carcinome du canal anal pour les patients âgés ? Analyse rétrospective de la toxicité dans un centre français et revue de la littérature

Abstract

PurposeTo study the tolerance to radiotherapy, with or without chemotherapy, followed by brachytherapy, in elderly patients (75 years or older) suffering from anal cancer. Patients and methodsWe treated 12 elderly patients with a curative intent. Median age was 78 years (range: 75–90). Ten patients had a stage II or IIIA (UICC 2009) tumour and six out of 12 were N+. Taking into account the age, the Eastern Cooperative Oncology Group (ECOG) performance status and comorbidities, five patients received exclusive radiotherapy (“RT group”) and seven a concomitant radiochemotherapy (“RT-CT group”). All patients received a boost by interstitial brachytherapy. One patient of the “RT-CT group” presented rectorragies during brachytherapy. The irradiation was completed by external beam radiotherapy focalized on the tumour volume. ResultsGrade 3 acute reactions (Radiation Therapy Oncology Group [RTOG]) were reported in three out of 12 patients. One grade 2–3 leucopoenia was observed in one out of 7 patients (“RT-CT group”). After brachytherapy, one grade 3 rectal toxicity (rectorragia) (in “RT group”) and one grade 4 (in “RT-CT group”) were observed. One patient (“RT-CT group”) presented a late grade 3 rectal toxicity (evaluated only for patients with at least 12 months of follow-up). ConclusionsConcomitant radiochemotherapy followed by brachytherapy showed an acceptable toxicity profile, and seems to be adapted in selected elderly patients. It could be recommended as reference treatment in elderly patients with a good physiological status.