ObjectiveTo evaluate the safety and efficacy of local excision in patients with T2 and T3 distal rectal cancers that have been downstaged by preoperative chemoradiation. Summary Background DataT2 and T3 cancers treated by local excision alone are associated with unacceptably high recurrence rates. The authors hypothesized that preoperative chemoradiation might downstage both T2 and T3 lesions and significantly expand the indications for local excision. MethodsLocal excision was performed after preoperative chemoradiation on patients with a complete clinical response or on patients who were either ineligible for or refused to undergo abdominoperineal resection. Local excision was approached transanally by removing full-thickness rectal wall and the underlying mesorectum. ResultsFrom 1994 to 2000, 95 patients with rectal cancers underwent preoperative chemoradiation and surgical resection for curative intent. Of these, 26 patients (28%), 19 men and 7 women, with a mean age of 63 years (range 44 -90), underwent local excision. Pretreatment endoscopic ultrasound classifications included 5 T2N0, 13 T3N0, 7 T3N1, and 1 not done. Pathologic partial and complete responses were achieved in 9 of 26 (35%) and 17 of 26 (65%) patients, respectively. Two of nine partial responders underwent immediate abdominoperineal resection. The mean follow-up was 24 months (median 19, range 6 -77). The only recurrence was in a patient who refused to undergo abdominoperineal resection after a partial response. There was one postoperative death from a stroke. This treatment was associated with a low rate of complications. ConclusionLocal excision appears to be an effective alternative treatment to radical surgical resection for a highly select subset of patients with T2 and T3 adenocarcinomas of the distal rectum who show a complete pathologic response to preoperative chemoradiation.Colorectal cancer is the third most common site for cancer in men and women in the United States. It is estimated that there will be 36,400 new diagnoses of rectal cancer and 8,600 deaths from rectal cancer in the year 2000.1 The current standard treatment for distal rectal cancer is abdominoperineal resection (APR), low anterior resection, or resection with coloanal anastomosis. These operations are associated with significant rates of death and complications, and local or distant recurrences occur in 10% to 65% of patients.2 The complications associated with radical rectal surgical procedures include urinary dysfunction in 10% to 70%, sexual dysfunction in 13% to 70%, and anastomotic leaks in 5% to 17%, with death rates of 2% to 6%.3-10 Compared with a radical resection for distal rectal cancer, local excision avoids a laparotomy, permanent colostomy, and the complications associated with pelvic dissection.The incidence of local recurrence even after radical surgery ranges from 10% to 29%.11-14 A recent review of published series reported an 18.5% overall local recurrence

494 Background: The emergence of intensity-modulated radiation therapy (IMRT) in the treatment of anal cancer has dramatically lowered the incidence of severe toxicity while maintaining excellent long-term outcomes. We compared our institutional experience using 3D conformal radiation therapy (3DCRT) versus IMRT for anal cancer. Methods: We performed a single-institution retrospective review of all non-metastatic squamous cell carcinoma anal cancer patients treated between 2000-2011 using definitive chemoradiation with curative intent. Results: This study included 89 consecutive anal cancer patients (37 3DCRT, 52 IMRT). Median follow-up for all patients, IMRT patients alone, and CRT patients alone was 26.5 months (range, 3.5-133.6), 20 months (range, 3.5-125.5), and 61.9 months (range, 7.6-133.6), respectively. Three-year overall survival (OS), progression free survival (PFS), locoregional control (LRC), and colostomy free survival (CFS) were 91.1%, 82.3%, 90.8%, and 91.3% in the IMRT cohort and 86.1%, 72.5%, 91.9%, and 93.7% for the 3DCRT patients (all p>0.1). More patients in the 3DCRT group required a treatment break (11 vs. 4; p=0.006), although the difference in median treatment break duration was not significant (12.2 vs. 8.0 days; p=0.35). Survival outcomes did not differ based on whether a treatment break was required (all p>0.1). Acute grade ≥3 non-hematologic toxicity was significantly decreased in the IMRT cohort (21.1 vs. 59.5%; p<0.0001). Acute grade ≥3 skin toxicity was significantly worse in the 3DCRT group (p<0.0001) while an improvement in late grade ≥3 GI toxicity was observed in the IMRT patients (p=0.012). Conclusions: This is the largest retrospective review comparing 3DCRT and IMRT for definitive treatment of anal cancer. In contrast to previously published data, this study demonstrates that while long-term outcomes do not significantly differ based on RT technique, a marked decrease in adverse effects and the need for a treatment break can be achieved using IMRT.

Emerging data suggests a benefit for using intensity modulated radiation therapy (IMRT) for the management of esophageal cancer. We retrospectively reviewed patients treated at our institution who received definitive or preoperative chemoradiation with either IMRT or 3D conformal radiation therapy (3DCRT) between October 2000 and January 2012. Kaplan Meier analysis and the Cox proportional hazard model were used to evaluate survival outcomes. We evaluated a total of 232 patients (138 IMRT, 94 3DCRT) who received a median dose of 50.4 Gy (range, 44-64.8) to gross disease. Median follow up for all patients, IMRT patients alone, and 3DCRT patients alone was 18.5 (range, 2.5-124.2), 16.5 (range, 3-59), and 25.9 months (range, 2.5-124.2), respectively. We observed no significant difference based on radiation technique (3DCRT vs. IMRT) with respect to median overall survival (OS) (median 29 vs. 32 months; P = 0.74) or median relapse free survival (median 20 vs. 25 months; P = 0.66). On multivariable analysis (MVA), surgical resection resulted in improved OS (HR 0.444; P < 0.0001). Superior OS was also associated on MVA with stage I/II disease (HR 0.523; P = 0.010) and tumor length ≤5 cm (HR 0.567; P = 0.006). IMRT was also associated on univariate analysis with a significant decrease in acute weight loss (mean 6% + 4.3% vs 9% + 7.4%, P = 0.012) and on MVA with a decrease in objective grade ≥3 toxicity, defined as any hospitalization, feeding tube, or >20% weight loss (OR 0.51; P = 0.050). Our data suggest that while IMRT-based chemoradiation for esophageal cancer does not impact survival there was significantly less toxicity. In the IMRT group there was significant decrease in weight loss and grade ≥3 toxicity compared to 3DCRT.

Background: The development of distant metastases of squamous cell carcinoma of the anal canal (SCCA) is rare but has a poor prognosis. A combination of carboplatin and paclitaxel is commonly used for treating squamous cell cancer in different organs, but its efficacy in advanced SCCA is unclear. The objective of this study is to determine the tolerability and outcome of patients with advanced SCCA on carboplatin plus paclitaxel treatment at the Moffitt Cancer Center. Methods: Retrospective analysis was conducted by looking at records from the Moffitt Cancer Center Tumor Registry from January 2007 to January 2012. Eligible patients had to have a diagnosis of SCCA and have received carboplatin plus paclitaxel every 3 weeks as part of the treatment plan. Results: Eighteen patients fulfilled the criteria; 14 were initially diagnosed with early-stage disease and received concurrent chemoradiation, but then relapsed. Median age was 56 years. Upon diagnosis of metastatic disease, 12 patients received carboplatin plus paclitaxel as a first-line treatment. Five patients had received prior systemic chemotherapy regimens and 1 had received prior local regional therapy. The response rate was high at 53% including 3 patients who achieved a complete response. Median overall survival was 12.19 months. Conclusions: Carboplatin and paclitaxel treatment shows encouraging activity in advanced SCCA.

No abstract