Definitive Irradiation and Chemotherapy for Radiosensitization in Management of Anal Carcinoma: Interim Report on Radiation Therapy Oncology Group Study No. 8314

Abstract

Following documented evidence of the synergism of 5-fluorouracil (5-FU) and radiation therapy and an additive effect with mitomycin and irradiation, pilot studies have demonstrated the potential for definitive radiation therapy in the management of squamous cell and basaloid carcinomas of the anal canal, allowing sphincter preservation. Our study explored the long-term effectiveness of combined therapy at this disease site and examined the feasibility of a Radiation Therapy Oncology Group study involving concomitant radiation therapy and chemotherapy. Between 1983 and 1987, 79 assessable patients with any primary tumor stage of anal canal carcinoma were treated by external-beam irradiation combined with mitomycin given by bolus iv injection and 5-FU given by continuous infusion. Radiation was delivered to the perineum and pelvis to a total dose of 4,080 cGy in 4.5-5 weeks. The inguinal nodal areas received 4,080 cGy, calculated at a 3-cm depth in the center of the nodal area. A 96-hour infusion of 5-FU was started on days 2 and 28 of the irradiation at a dose of 1,000 mg/m2 over 24 hours, and a bolus injection of mitomycin was administered on day 2 at a dose of 10 mg/m2. The overall survival rates are 97% at 1 year and 73% at 3 years. Patients with lesions less than 3 cm in diameter and those treated strictly according to the protocol did significantly better than those with larger lesions and those whose treatment did not comply with the protocol. The interim outcome of the study demonstrates that this combined therapy is effective for patients with anal cancer and allows preservation of the sphincter and of sexual function.

US Intergroup Anal Carcinoma Trial: Tumor Diameter Predicts for Colostomy

“…However, disease-free survival (DFS) and overall survival (OS) rates vary considerably, depending predominantly on the established pretreatment prognostic variables such as sex, clinical nodal status, and tumor diameter. [3][4][5][6] Approximately, 25% of patients have clinically node-positive cancer and/or Ն 5 cm tumor diameter 6 ; the larger the primary tumor, the higher the likelihood of lymph node metastases. 7 Although the DFS rates can range from 55% to 65%, these do not necessarily correspond with the colostomy rates, which are often, fortunately, considerably lower.…”

Photodynamic therapy for anal cancer

“…With further evaluation it has become evident that patients with bulky tumors (T 3 ) treated with chemoradiation have a local failure rate approaching 10-20% or more [9]. Most of these patients will then undergo radical surgery for salvage with resultant permanent colostomy.…”

Carcinoma espinocelular de canal anal: análise de 11 casos

“…Associada à quimioterapia, realiza-se a radioterapia com dose de radiação entre 4500 e 5500cGy, dividida em 5 semanas (20,30,31,32) . Nos estádios iniciais, menores doses de radiação (3000cGy) têm bons resultados com menos efeitos colaterais (34,35) . Com esta terapêutica, observa-se índice de sobrevida de 70%, após 5 anos.…”