A B S T R A C T PurposeTo determine whether increased duration of radiation therapy (RT) and overall treatment (RX) time has a detrimental effect in anal cancer. Patients and MethodsData from Radiation Therapy Oncology Group (RTOG) 87-04 and RTOG 98-11 trials were combined to form three treatment groups: RT/fluorouracil (FU)/mitomycin (n ϭ 472), RT/FU/ cisplatin (n ϭ 320), and RT/FU (n ϭ 145). Cox proportional hazards models were used with the following variables: RT duration, RT intensity, RX duration, treatment group, age, sex, Karnofsky performance score (KPS), T stage, N stage, and RT dose. ResultsIn the univariate analysis, there was a significant association between RX duration and colostomy failure (CF; hazard ratio [HR] ϭ 1.51; 95% CI, 1.07 to 2.14; P ϭ .02), local failure (HR ϭ 1.52; 95% CI, 1.14 to 2.03; P ϭ .005), locoregional failure (HR ϭ 1.51; 95% CI, 1.15 to 1.98; P ϭ .003), and time to failure (HR ϭ 1.40; 95% CI, 1.10 to 1.79; P ϭ .007). The significance of RX duration was maintained after adjusting for treatment group. In multivariate modeling there was a trend toward an association between RX duration and CF (HR ϭ 1.57; 95% CI, 0.98 to 2.50; P ϭ .06) and a statistically significant association with local failure (HR ϭ 1.96; 95% CI, 1.34 to 2.87; P ϭ .0006). Age, sex, KPS, T stage, N stage, and RT dose, but not RT duration, RT intensity, or RX duration, were found to be statistically significant predictors of OS and colostomyfree survival. ConclusionTotal treatment time, but not duration of radiation therapy, seems to have a detrimental effect on local failure and colostomy rate in anal cancer. Induction chemotherapy may contribute to local failure by increasing total treatment time.

Early stasis occurred in approximately 20% of infusions with similar incidences in hyper- and hypovascular tumours. Whole-liver therapy reduced the incidence of stasis. Stasis did not appear to affect initial imaging outcomes.

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