Anal cancer in Sweden 2015–2019. Implementation of guidelines, structural changes, national registry and early results

Johnsson, Anders; Norman, David; Angenete, Eva; Cavalli-Björkman, Nina; Lagerbäck, Cecilia; Leon, Otilia; Lindh, Birgitta; Lydrup, Marie‐Louise; Nilsson, Martin; Perman, Mats; Radu, Calin; Zackrisson, Björn

doi:10.1080/0284186x.2022.2048069

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…For instance, the patients were not staged with MRI or PET-CT, and RT was delivered with static fields. The DFS (55%) and OS (69%) at 5 years is much lower compared with what is reported from more recent studies[1,2,13]. A similar, but smaller Australian study from 2018 reported the oncologic outcome in 51 patients treated with different RT volumes at a single centre[1994][1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006][2007]…”

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confidence: 60%

Reduction of elective lymph node volume in radiotherapy of early anal squamous cell cancer: a comparative study between two Swedish university hospitals

Heyman,

Perman,

Radu

2024

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Background: Anal squamous cell cancer (ASCC) in early stages (T1–2N0M0) is treated with chemoradiotherapy with a 3-year overall survival (OS) exceeding 90%. In Swedish guidelines, it has been optional to include the external iliac and presacral lymph node (LN) stations in radiotherapy (RT) treatment fields in early ASCC. Two Swedish hospitals treating ASCC (SU: Sahlgrenska University Hospital; UU: Uppsala University Hospital) have chosen different approaches since 2010. Material and methods: This study included consecutive patients with early ASCC (T1–2N0M0) treated between 2010 and 2017 at both sites (SU n = 70; UU n = 46). Data were retrieved from medical records and RT charts. Results: At SU, the external iliac and presacral LN stations were included in elective LN irradiation in 96.8% (n = 60) and 95.2% (n = 59) patients compared to 2.4% (n = 1) and 29.3% (n = 12) at UU. The mean elective LN volume was 2,313 cc (interquartile range [IQR] 1,951–2,627) in the SU cohort compared to 1,317 cc (IQR 1,192–1,528) in the UU cohort, p < 0.0001. No case of regional LN recurrence was seen in either cohort. Disease specific survival (DSS) at 5 years was 95.7% (confidence interval [CI] 90.1–100.0) in the SU cohort and 97.8% (CI 93.2–100.0) in the UU cohort (p 0.55). OS at 5 years was 84.5% (CI 76.1–93.0) in the SU cohort and 82.6% (CI 69.6–89.1) in the UU cohort (p 0.8). Interpretation: We found no differences in regional recurrence, DSS or OS between the cohorts treated with different elective LN volumes. In this population-based study, reduction of RT volume in early ASCC did not lead to inferior outcome.

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Reduction of elective lymph node volume in radiotherapy of early anal squamous cell cancer: a comparative study between two Swedish university hospitals

Heyman,

Perman,

Radu

2024

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“…Intensity‐modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) with simultaneously integrated boost (SIB) becoming the standard technique. First choice of chemotherapy became 5‐Fu + mitomycin C or capecitabin + mitomycin C [34]. Lower doses and modern techniques such as IMRT/VMAT are also expected to generate less severe long‐term side effects.…”

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confidence: 99%

Patient reported long‐term side effects on bowel function and anal pain in anal cancer survivors – 3‐ and 6‐year results from the Swedish national ANCA study

Axelsson,

Johansson,

Haglind

et al. 2023

Colorectal Disease

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AimThe primary therapeutic option for anal cancer treatment is chemoradiotherapy resulting in 80% survival. The aim of this study was to assess long‐term bowel function impairment and anal pain at 3 and 6 years after anal cancer diagnosis, based on a hypothesis of an increase in impairment over time. A secondary aim was to investigate if chemoradiotherapy increased the risk for bowel impairment, compared to radiotherapy alone.MethodThe ANal CAncer study (ANCA) consists of a national Swedish cohort of patients diagnosed with anal cancer between 2011–2013. Patients within the study were invited to respond to a study‐specific questionnaire at 3‐ and 6‐years after diagnosis. Descriptive analyses for the primary endpoint and ordinal logistic regressions for secondary endpoint were performed.ResultsA total of 388 patients (84%) were included in the study. At 3 years of follow‐up, 264 patients were alive. A total of 195 of these patients (74%) answered a study specific questionnaire, and at 6 years 154 patients (67%). Fifty‐seven percent experienced bowel urgency at both 3 and 6 years. There was an increased risk for repeated bowel movement within 1 h (OR 2.44 [95% CI: 1.08–5.61, p = 0.03]) at 3 years in patients who had been treated by chemoradiation compared to radiotherapy alone.ConclusionsImpairment in bowel function and anal pain after anal cancer treatment should be expected and remains after 6 years. This suggests that long‐term follow‐up may be necessary in some form after customary follow‐up. The addition of chemotherapy increases long‐term side effects of bowel function.

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MRI morphological characteristics of lymph nodes in anal squamous cell carcinoma

Gulevski,

Frennered,

Trägårdh

et al. 2024

Abdom Radiol

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Objectives Pre-treatment staging of anal squamous cell carcinoma (ASCC) includes pelvic MRI and [18F]-fluorodeoxyglucose positron emission tomography with computed tomography (PET-CT). MRI criteria to define lymph node metastases (LNMs) in ASCC are currently lacking. The aim of this study was to describe the morphological characteristics of lymph nodes (LNs) on MRI in ASCC patients with PET-CT-positive LNs. Methods ASCC patients treated at Skåne University Hospital between 2009 and 2017 were eligible for inclusion if at least one positive LN according to PET-CT and a pre-treatment MRI were present. All PET-CT-positive LNs and PET-CT-negative LNs were retrospectively identified on baseline MRI. Each LN was independently classified according to pre-determined morphological characteristics by two radiologists blinded to clinical patient information. Results Sixty-seven ASCC patients were included, with a total of 181 PET-CT-positive LNs identified on baseline MRI with a median short-axis diameter of 9.0 mm (range 7.5–12 mm). MRI morphological characteristics of PET-CT-positive LNs included regular contour (87%), round shape (89%), and homogeneous signal intensity on T2-weighed images (67%). An additional 78 PET-CT-negative LNs were identified on MRI. These 78 LNs had a median size of 6.8 mm (range 5.5–8.0 mm). The majority of PET-CT-negative LNs had a regular contour, round shape, and a homogeneous signal that was congruent to the primary tumor. Conclusions There are MRI-specific morphological characteristics for pelvic LNs in ASCC. PET-CT-positive and negative LNs share similar morphological features apart from size, with PET-CT-positive LNs being significantly larger. Further studies are needed to determine discrimination criteria for LNM in ASCC.

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Anal cancer in Sweden 2015–2019. Implementation of guidelines, structural changes, national registry and early results

Cited by 3 publications

References 19 publications

Reduction of elective lymph node volume in radiotherapy of early anal squamous cell cancer: a comparative study between two Swedish university hospitals

Reduction of elective lymph node volume in radiotherapy of early anal squamous cell cancer: a comparative study between two Swedish university hospitals

Patient reported long‐term side effects on bowel function and anal pain in anal cancer survivors – 3‐ and 6‐year results from the Swedish national ANCA study

MRI morphological characteristics of lymph nodes in anal squamous cell carcinoma

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