Squamous cell carcinoma of the anal canal at the Queen Elizabeth Hospital: A local experience

Abstract

6126 Background: Abdominal-perineal resection (APR) with or without chemo radiation (CRT) was a standard treatment for squamous cell carcinoma of anal canal. Subsequently a series of clinical trials have clearly demonstrated that CRT as primary treatment results in improvement in local regional control, colostomy free survival and disease-free survival. The aims of this study are to determine what is the local practice and outcomes in a single centre. Methods: All patients with squamous cell carcinoma of the anus treated in TQEH over 6-year period (1998–2004) were identified. A standardised chemoradiotherapy protocol was used - 36 Gy in 20 fractions to the pelvis using a 3–4 field technique followed by a dose of 14.4 -18.0 Gy, in 8–10 fractions, to macroscopic disease (primary and nodes) combined with mitomycin C/CVI 5fluorouracil. Baseline data were collected prospectively. Results: A total of 35 patients were reviewed during the study period: 14 men and 21 women with a median age of 64 years. After diagnosis 77% of patients had chemo radiotherapy as first line treatment. 23% local recurrence rates were found and all had salvage abdominal-perineal resection. The 3 and 5 year overall survival for all patients was 75% & 53%. For patients undergoing primary CRT, the 3 and 5 year disease free survival (DFS) was 62% & 53%. The median survival has not been reached. For patients undergoing primary surgery - 3 year DFS is 62%. The median survival for those patients undergoing salvage surgery was 41.5 months, with a 3 year DFS of 50%. One patient with local recurrence subsequently underwent hepatic resection for an isolated metastasis 10 months out from diagnosis and is disease free 5 months post resection. CRT was generally well tolerated although there was one unexplained death at the completion of CRT. Conclusions: This series demonstrates combined chemo radiotherapy is used as first line treatment in the majority of patients with similar outcomes to those reported in other trials. Furthermore this series confirms that salvage surgery achieves prolonged survival. Despite these results, nearly 50% of patients still die of this disease by 5 years and further research assessing the impact of newer chemotherapy agents or targeted drugs is warranted. No significant financial relationships to disclose.