Abstract
PurposeTo evaluate quality of life (QOL) and outcome of patients with anal carcinoma treated with short split-course chemoradiation (CRT).MethodsFrom 1991 to 2005, 58 patients with anal cancer were curatively treated with CRT. External beam radiotherapy (52 Gy/26 fractions) with elective groin irradiation (24 Gy) was applied in 2 series divided by a median gap of 12 days. Chemotherapy including fluorouracil and Mitomycin-C was delivered in two sequences. Long-term QOL was assessed using the site-specific EORTC QLQ-CR29 and the global QLQ-C30 questionnaires.ResultsFive-year local control, colostomy-free survival, and overall survival were 78%, 94% and 80%, respectively. The global QOL score according to the QLQ-C30 was good with 70 out of 100. The QLQ-CR29 questionnaire revealed that 77% of patients were mostly satisfied with their body image. Significant anal pain or fecal incontinence was infrequently reported. Skin toxicity grade 3 or 4 was present in 76% of patients and erectile dysfunction was reported in 100% of male patients.ConclusionsShort split-course CRT for anal carcinoma seems to be associated with good local control, survival and long-term global QOL. However, it is also associated with severe acute skin toxicity and sexual dysfunction. Implementation of modern techniques such as intensity-modulated radiation therapy (IMRT) might be considered to reduce toxicity.
Highlights
Sphincter-sparing chemoradiation (CRT) has evolved as the standard of care for most patients with squamous cell carcinoma of the anal canal
Combined CRT was first introduced by Nigro et al in the mid-1970s, and has resulted in improved local and regional control, colostomy free survival, and disease-free survival since [1,2,3,4]
The histopathological diagnosis was established according to the World Health Organization (WHO) criteria [7]
Summary
Sphincter-sparing chemoradiation (CRT) has evolved as the standard of care for most patients with squamous cell carcinoma of the anal canal. Combined CRT was first introduced by Nigro et al in the mid-1970s, and has resulted in improved local and regional control, colostomy free survival, and disease-free survival since [1,2,3,4]. Mortality to incidence ratio was 14% (660 estimated deaths in the United States in 2006) implying that the majority of patients with anal cancer have a good prognosis [5]. Split duration was 6 weeks, but was reduced in the recent years. Though acute toxicities have been reported to be moderate and long-term toxicities to be acceptable after 3 years, long-term QOL has not yet been evaluated after this regimen
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