Chemoradiotherapy of anal cancer is feasible in elderly patients: Treatment results of mitomycin–5-FU combined with radiotherapy at Helsinki University Central Hospital 1992–2003

Saarilahti, Kauko; Arponen, Päivi; Vaalavirta, Leila; Tenhunen, Mikko; Blomqvist, Carl

doi:10.1080/02841860600849075

Cited by 15 publications

(12 citation statements)

References 20 publications

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“…In multivariable analysis, age over 65 years at diagnosis was a strong indicator. This is not in accordance with at least one previous report [20]. In the present material, the two age groups were balanced with regards to number of patients, intent of treatment and radio/chemotherapy doses (results not presented).…”

Section: Discussionsupporting

confidence: 39%

Anal carcinoma in mid-Norway 1970–2000

et al. 2007

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The treatment of anal carcinoma changed from surgery to chemoradiotherapy 20-25 years ago. The aim of this observational study was to compare surgery with chemoradiotherapy with regard to side effects, local recurrence and survival during and after the implementation of a new treatment policy for anal carcinoma. The study includes all 111 patients with anal carcinoma diagnosed between 1970 and 2000 in mid-Norway. One hundred patients were treated with the intention to cure, and 11 patients received palliative treatment. Thirty-four patients were treated with surgery alone, and 57 patients with chemoradiotherapy. Among patients treated for cure, 17 patients (17%) developed local recurrence; ten patients (33%) in the surgically treated group and 4 (7%) in the chemoradiotherapy group (p = 0.15). Five year overall survival was 48% after surgery, compared to 78% after chemoradiotherapy (p = 0.004). Stage, age and treatment were all significant indicators of survival in uni- and multivariable analysis. Late side effects were moderate after combined therapy; only one patient preferred getting a stoma due to radiation damage of the anal sphincter. The change of strategy for anal cancer treatment from surgery to combined therapy has probably reduced local recurrence and improved survival. Side effects in this series of patients were minor after chemoradiotherapy compared to a permanent stoma after surgery.

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Section: Discussionsupporting

confidence: 39%

Anal carcinoma in mid-Norway 1970–2000

et al. 2007

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“…The limited retrospective studies examining definitive treatment of SCCA in the elderly have shown mixed results, although data from other disease sites, such as non-small cell lung cancer, suggest that the elderly, if eligible, should receive SOC therapy. [7][8][9][10] In common malignancies (eg, non-small cell lung cancer), few prospective studies have focused on curative treatment of the elderly. 11,12 For SCCA, which represents 0.5% of new cancer cases in the United States, prospective trials to determine optimal treatment of the elderly would be challenging to conduct.…”

Section: Introductionmentioning

confidence: 99%

“…younger patients. Saarilahti et al10 reported on 62 patients treated with CRT for SCCA (37% aged $70 years). Treatment was more modern, including use of intensity-modulated radiation therapy (IMRT).…”

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confidence: 99%

Disparate Use of Chemoradiation in Elderly Patients With Localized Anal Cancer

Miller¹,

Nalin²,

Diaz³

et al. 2022

Journal of the National Comprehensive Cancer Network

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Background: The incidence of squamous cell carcinoma of the anus (SCCA) is increasing, particularly among the elderly (age ≥65 years). We sought to compare patterns of care for the treatment of SCCA in elderly versus nonelderly patients. Methods: Data for patients with stages I–III SCCA diagnosed from 2004 through 2015 were obtained from the National Cancer Database. Patients were categorized as having received standard-of-care (SOC) chemoradiation (CRT) with multiagent chemotherapy, non-SOC therapy, palliative therapy, or no treatment. Differences in treatment groups were tested using the chi-square test. We used logistic regression to identify predictors of SOC CRT and multiagent versus single-agent chemotherapy in patients receiving CRT. Propensity score matching was used to compare overall survival (OS) in elderly patients receiving multiagent versus single-agent chemotherapy for those receiving CRT. Results: We identified 9,156 elderly and 17,640 nonelderly patients. A lower proportion of elderly versus nonelderly patients (54.5% vs 65.0%; P<.0001) received SOC CRT than other treatments or no treatment. In multivariate analysis, elderly patients were 38% less likely than nonelderly patients to receive SOC CRT (odds ratio, 0.62; 95% CI, 0.58–0.65; P<.0001). A higher proportion of the elderly were treated with single-agent versus multiagent chemotherapy (16.9% vs 11.8%; P<.0001), which resulted in a >1.5-fold increase in the likelihood of elderly patients receiving single-agent chemotherapy (odds ratio, 1.52; 95% CI, 1.39–1.66) in multivariate analysis. After propensity score matching, 3-year OS was higher in elderly patients who received CRT with multiagent versus single-agent chemotherapy (77.1% vs 67.5%; hazard ratio, 0.78; 95% CI, 0.68–0.89; P=.0002). Conclusions: In this comprehensive study of patients with stages I–III SCCA, elderly patients were less likely than nonelderly patients to receive SOC CRT. The low proportion of elderly patients receiving SOC CRT with multiagent chemotherapy for localized anal cancer suggests that the optimal treatment approach for this vulnerable population remains undefined.

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“…Modified Charlson Comorbidity index (54) had no impact on outcome (55). Good tolerance among elderly and comparable tumour control with the younger cohorts was confirmed by others (26,56). In the original Papillon experience, BT was applied in tumours <4 cm, involving <2/3 of circumference and with good response to EBRT (30).…”

Section: Patient Selection For Brachytherapy Boostmentioning

confidence: 85%

“…In a series from Finland, pelvic IMRT (n=20) or 3D conformal radiotherapy (3D CRT) (n=39), was followed by HDR BT boost. There was significantly less grade 3-4 diarrhoea and dermato-mucositis and shorter inter-sequence gap in IMRT than 3D CRT group (56). In summary, under a premise of equivalent OTTs, it can be reasonable to hypothesize superiority of BT over EBRT boost due to inherent radiobiological and physical advantages of BT (Figure 1, Table 3).…”

Section: Toxicitymentioning

confidence: 92%