No abstract

Aim Squamous cell carcinomas of the anus are normally treated with synchronous chemoradiotherapy (CRT). Small, localized anal margin tumours may be adequately treated by local excision (LE) alone. This study aims to investigate the outcomes of patients with anal margin tumours treated with LE alone, reserving the use of CRT for salvage on local recurrence (LR). Methods Patients with small, localized (stage I/IIA) anal margin tumours treated by LE from October 1999 to September 2018 were identified. The effect of tumour size and resection margin on LR risk was analysed. Outcomes of overall survival and disease‐free survival were measured. Results Fifty‐five patients with anal margin tumours were identified. Overall 5‐year LR, overall survival and disease‐free survival rates were 8%, 86% and 82% respectively. Of the seven LRs, five were successfully salvaged with CRT with no further recurrence and two were not fit for CRT. Resection margins in non‐fragmented tumours and tumour size did not significantly influence LR risk. Conclusions Most small, localized anal margin tumours can be adequately treated by LE alone with low LR rates. Most patients who developed LR were salvaged using CRT, with no cancer‐related deaths reported.

Objective: There is a paucity of evidence for external beam radiotherapy (EBRT) in patients with non-metastatic prostate adenocarcinoma with regional lymph nodes (cN1) as primary treatment in addition to androgen deprivation therapy (ADT). We present the retrospective outcomes of cN1 patients treated with prostate and pelvic nodal (PPLN) EBRT and ADT. Methods: The clinical records of cN1 patients given PPLN EBRT from January 2012 until January 2020 were retrospectively reviewed. Primary outcomes of overall survival (OS), prostate cancer specific survival (PCSS), and failure-free survival (FFS) were analysed. Secondary outcomes of biochemical relapse-free survival (BRFS), loco-regional recurrence-free survival (LRFS), and distant metastases-free survival (DMFS) were also reviewed. The prognostic values of clinicopathological parameters were investigated. Treatment toxicity was also reviewed. Results: We identified 121 cN1 patients treated with PPLN EBRT and ADT. Treatment was well tolerated, with only a minority (1.7%) having Grade 3 toxicities. Five-year OS and PCSS were 74.4 and 89.1% respectively. Five-year FFS was 55.4%; with 5 year BRFS, LRFS, and DMFS at 56.2%, 85.2%, and 65.4% respectively. The benefits of PPLN EBRT were seen in most patients, with prolonged failure-free period and good loco-regional control. Conclusion: Patients with cN1 disease should be considered for PPLN EBRT, in addition to ADT. Treatment is well tolerated with low toxicity, good loco-regional control, and prolonged time to disease progression. Advances in knowledge: We report real world experience of cN1 patients treated with PPLN EBRT in addition to ADT, with good outcomes following treatment and low toxicity.