Anal cancer chemoirradiation with curative intent – a single institution experience

Abstract

Results of radiochemotherapy in 50 patients with squamous cell carcinoma of the anal canal, treated with radical radiochemotherapy between January 2003 and September 2007, at the Institute of Oncology Ljubljana are presented. The treatment schedule consisted of 3-D conformal external beam radiotherapy (45 Gy in 25 fractions), with two cycles of concurrent chemotherapy (5-fluorouracil (5-FU) / Mitomycin C), followed by brachytherapy or external beam boost (15-30 Gy) to the primary tumor. Locoregional control (LRC), disease-free survival (DFS), disease-specific survival (DSS), overall survival (OS) and colostomy-free survival (CFS) rates and the rate of acute and chronic side-effects were estimated. The impact of individual tumor-and therapy-related factors on treatment outcome was assessed.Treatment was completed according to the protocol in 72% of patients. The median follow-up time of 40 survivors was 22 months (range 1.7-53.2 months). At 2 years, LRC, DFS, DSS, OS and CFS rates were 68%, 67%, 87%, 76% and 85%, respectively. In the multivariate analysis, nodal stage was identified as an independent prognostic factor for LRC, DSS and CFS and application of Mitomycin C for OS. The most frequent acute side-effect of treatment was radiodermatitis (grade 3 in 66% of patients, grade 4 in 2%). Late anal stenosis, chronic ulceration and grade 2-3 incontinence developed in 3 (6 %), 2 (4 %) and 5 (10 %) of colostomy-free survivors, respectively.Radiotherapy with concurrent 5-FU / Mitomycin C chemotherapy is feasible, with acceptable toxicity. The presented treatment outcome is comparable to other published results.

Late gastrointestinal toxicity after radiotherapy for anal cancer: a systematic literature review

“…The reported rate of FI following radiotherapy ranged, from 0 to 44% [18,[31][32][33][34][35][36][37][38][39][40][41][42]. Between 0.5 and 10.9% of anal cancer survivors were reported to have needed a colostomy due to severe anal sphincter dysfunction at a median follow-up of 32.4 months to 8.6 years [43][44][45][46][47][48][49][50][51].…”

Long term outcome after combined modality treatment for anal cancer

“…Numerous trials have demonstrated complete response rates of 80–90%, with high local control, survival and sphincter preservation rates following radical radiochemotherapy 3,10–12. The purpose of our retrospective study was to evaluate the effectiveness and toxicity of radiochemotherapy in a single-centre prospective cohort of patients with squamous cell carcinoma of the anal canal.…”

Secondary anal fissures: a pain in the a**

“…Especially after radiotherapy for anal canal cancer perianal and anal ulcerations can be encountered. Oblak et al describes non-healing anal ulcers in 4% after radiochemotherapy for anal carcinoma (50). A systematic review by Pan et al on late GI complications after radiation therapy for anal canal cancer report anorectal ulceration in 1 to 22.6% of patients (51).…”