Concurrent chemoradiotherapy for squamous cell carcinoma of the anus using a shrinking field radiotherapy technique without a boost

Abstract

Chemoradiotherapy (CRT) is now widely accepted as the primary treatment modality for squamous cell cancer of the anus. While randomised trials have clearly shown CRT to be more effective than radiotherapy alone, there remains uncertainty over the optimal integration of chemotherapy and radiation. We describe a series of 50 patients treated by a site specialist gastrointestinal nonsurgical oncologist with CRT at a single UK centre. Chemotherapy comprised mitomycin C (MMC) (day 1) and 5-fluorouracil (5-FU) (days 1 -4, and 29 -32), concurrent with 50 Gy in 25 fractions radiation, using a two-phase shrinking field technique. A radiation boost was not planned. At a median follow-up of 48 months, 11 (22%) of the patients have failed locally, of which three have been surgically salvaged. Nine (18%) have died of anal cancer. These results are comparable with those from large randomised studies, and suggest that a two-phase shrinking field radiotherapy technique with no boost, concurrent with MMC/5-FU chemotherapy, is an effective regimen for this disease. The CRT regimen described here provides the basis for the 'control arm' of the current UK-randomised CRT trial in anal cancer (ACT2).

Defunctioning stomas prior to chemoradiation for anal cancer are usually permanent

“…The outcome of patients who did not undergo reversal is poor. Thus the crude local control of 57% and the 3‐year actuarial survival of 48% are less when compared with 3‐year survival and local control rates of 79% and 77%, respectively, of 119 patients treated with radical intent over a 6‐year period in our centre [8]. The poor outcome reflects the locally advanced nature of the disease, indicated by size, T‐stage and nodal positivity.…”

“…All patients were treated by a defined institutional protocol using a ‘shrinking field’ technique as previously described [8] and subsequently adopted as the standardized radiotherapy approach used in the NCRI ACT2 trial [5]. Gross tumour volume (GTV) was defined as all macroscopic primary tumours and clinically or radiologically involved nodes.…”

Effective treatment of anal cancer in the elderly with low-dose chemoradiotherapy

“…Of these three, two had large T3 tumours at presentation. Other groups have reported similar findings of reduced local control for patients with more advanced tumours (Cummings et al, 1991;Melcher and Sebag-Montefiore, 2003). For these patients there are a number of possible ways to improve our regimen without increasing the dose of radiotherapy.…”

“…The protocol used in our patients was developed from the phase II studies reported by Nigros group and our own experience of using a total of 30 Gy to microscopic disease and a boost dose of 20 Gy to macroscopic disease without a planned gap in our standard regimen (Melcher and Sebag-Montefiore, 2003). To date we have not seen any isolated failures in the low-dose region.…”

Electronic self-reporting of adverse events for patients undergoing cancer treatment: the eRAPID research programme including two RCTs

“…Radiotherapy for pelvic malignancies typically involves daily attendance for treatment, often with surgery, chemotherapy and biological therapies. [160][161][162][163] These produce acute and late effects, peaking after treatment finishes (typically bowel and urinary toxicity). 106,110 To capture these late effects, radiotherapy patients need a longer and often multidisciplinary follow-up, and, for this reason, the pathways may be unclear.…”