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

Abstract

Chemoradiotherapy (CRT) is accepted as the standard initial treatment for squamous cell anal cancer. However, frail elderly patients cannot always tolerate full-dose CRT. This paper reports the results of a modified regimen for this group of patients. In all, 16 patients with biopsy-proven squamous cell carcinoma of the anal canal or margin and performance status or co-morbidity precluding the use of full-dose CRT were included in this protocol. The median age was 81 (range 77 -91). Patients received a dose of 30 Gy to the gross tumour volume plus 3 cm margin in all directions. Concurrent chemotherapy comprised 5-fluorouracil 600 mg m À2 given over 24 h on days 1 -4 of radiotherapy. The treatment was well tolerated. All 16 patients completed treatment as planned. Only one patient experienced any grade 3 toxicity (skin). The local control at a median follow-up of 16 months was 73% (13 out of 16). The overall survival was 69% and disease-specific survival 86%. This is a well-tolerated regimen for elderly/poor performance patients with anal cancer, which can achieve high rates of local control and survival. Longer follow-up will determine whether these encouraging results are maintained.

Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Anal Cancer

“…On the other hand, many patients with anal cancer will not tolerate standard CRT due to co‐morbidities or poor performance status. Using low dose CRT (30–40 Gy) can be a safer and yet effective compromise, especially for smaller tumours but longer follow‐up data are needed (Charnley et al ., ; Glynne‐Jones et al ., ; Smith et al ., ).…”

Treatment de-intensification strategies for head and neck cancer

“…The total radiation dose of 36 Gy is delivered in 20 fractions in 1.8 Gy twice daily dosing 5 d/week with concurrent weekly docetaxel. This reduced radiation dosing is inspired by studies showing lower doses are able to control disease in anal cancer, another HPV-associated squamous cell cancer [68]. Eligible patients must have at least one of the following risk factors: lymph node >3 cm, two or more metastatic lymph nodes, perineural invasion, lymphovascular invasion, ECE, pT3, or microscopic pT4a tumour stage.…”

Anal carcinoma of the elderly treated with radiotherapy alone or with concomitant radio-chemotherapy

“…Charnley et al [15] more recently reported on a modified schedule in 16 patients aged 75 or over who were deemed unsuitable for the standard schedule. Patients received a dose of 30 Gy to the gross tumor volume and concurrent CT with 5FU only at 600 mg/m 2 iv ci days 1-4.…”