Feasibility of weekly cisplatin and radiotherapy for localized anal cancer – A Danish anal cancer group report

Abstract

BackgroundChemoradiotherapy (CRT) with flourouracil and mitomycin is the standard treatment for squamous cell carcinoma of the anus (SCCA), however the associated acute toxicity often hinders compliance. Although weekly cisplatin is a well-established treatment for other squamous cell carcinomas, it has not been explored in SCCA. PurposeTo investigate if radiotherapy (RT) with weekly cisplatin is a feasible option for SCCA and to report the acute toxicity. Material/methodsPatients were treated with RT and weekly cisplatin 40 mg/m2 between 1998–2020. Retrospective data from medical records (n = 65) and prospectively collected data from an observational study (n = 51) comprising physicianassessed toxicity (NCI-CTCAE 4.0), patient-reported outcomes (EORTC-QlQC30 + CR29) baseline, mid-therapy, end of treatment and 2–4 weeks post-treatment were included. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. ResultsWe included 116 patients. T-stages were T1:4 %, T2: 71 %, T3: 17 %, T4: 8 % and 47 % has N + disease. RT doses were 53.75–64 Gy/45–51.2 Gy and the mean cumulative dose of cisplatin was 307.5 mg. The median overall treatment time was 43 days. Within 6 months after CRT 88.9 % had complete response. The median follow-up time was 4.5 years and 5-year DFS and OS were 77 % (95 %CI 68.7–84.5 %) and 86.4 % (95 %CI 78.3–91.7 %), respectively. Hospitalization occured in 20 % with 2.6 % being admitted due to febrile neutropenia. Hematological toxicty was low with 13.7 % grade 3 and 3.9 % grade 4. Anal pain, skin, gastrointestinal and urogenital toxicity were mild. ConclusionRT and weekly cisplatin for SCCA showed good outcome results and an acceptable acute toxicity profile.