Radiotherapy alone versus chemoradiotherapy for stage I anal squamous cell carcinoma: a systematic review and meta-analysis

Talwar, Gaurav; Daniel, Ryan; McKechnie, Tyler; Levine, Oren; Eskicioglu, Cagla

doi:10.1007/s00384-021-03846-5

Cited by 4 publications

(4 citation statements)

References 55 publications

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“…A systematic review and meta-analysis comparing outcomes in patients with stage I anal carcinoma found an increased 5-year OS in patients treated with chemoRT compared with RT alone (RR, 1.18; 95% CI, 1.10-1.26; P,.00001) but no significant difference in 5-year DSF (RR, 1.01; 95% CI, 0.92-1.11; P5.87. 127 Conversely, a population-based cohort analysis of Medicare-eligible (.65 years of age or with an eligible disability) patients with stage I anal cancer showed no difference in OS, cause-specific survival, colostomy-free survival, or DFS with chemoRT versus RT alone after adjustment using propensity score methods. 128 Therefore, this study concludes that RT alone may allow for adequate oncologic outcomes for highly select patients with stage I anal cancer, although it is important to note that this study did not differentiate between anal canal and perianal cancers.…”

Section: Chemotherapymentioning

confidence: 97%

Anal Carcinoma, Version 2.2023, NCCN Clinical Practice Guidelines in Oncology

Benson,

Venook,

Al-Hawary

et al. 2023

Journal of the National Comprehensive Cancer Network

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This discussion summarizes the NCCN Clinical Practice Guidelines for managing squamous cell anal carcinoma, which represents the most common histologic form of the disease. A multidisciplinary approach including physicians from gastroenterology, medical oncology, surgical oncology, radiation oncology, and radiology is necessary. Primary treatment of perianal cancer and anal canal cancer are similar and include chemoradiation in most cases. Follow-up clinical evaluations are recommended for all patients with anal carcinoma because additional curative-intent treatment is possible. Biopsy-proven evidence of locally recurrent or persistent disease after primary treatment may require surgical treatment. Systemic therapy is generally recommended for extrapelvic metastatic disease. Recent updates to the NCCN Guidelines for Anal Carcinoma include staging classification updates based on the 9th edition of the AJCC Staging System and updates to the systemic therapy recommendations based on new data that better define optimal treatment of patients with metastatic anal carcinoma.

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Section: Chemotherapymentioning

confidence: 97%

Anal Carcinoma, Version 2.2023, NCCN Clinical Practice Guidelines in Oncology

Benson,

Venook,

Al-Hawary

et al. 2023

Journal of the National Comprehensive Cancer Network

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“…Talwar et al performed a systematic review and meta-analysis comparing RT to CRT for stage I SCCA patients [ 5 ]. The authors included five retrospective studies with 3784 patients treated with CRT and 415 patients treated with RT.…”

Section: Chemoradiation Versus Radiation Therapy Alonementioning

confidence: 99%

“…However, the incidence of SCCA is increasing, particularly in the elderly, with an almost 5% increase in mortality due to this malignancy in the most vulnerable [ 2 ]. While the current standard of care treatment for localized SCCA is radiation therapy (RT) with concurrent multiagent chemotherapy, questions remain if this potentially toxic and morbid treatment is appropriate for those with early-stage disease (e.g., T1–2 N0) [ 3 , 4 , 5 , 6 ]. In other HPV-related malignancies, such as head and neck cancer, there has been a recent emphasis placed on careful de-escalation of therapy to potentially mitigate against acute and late treatment-related toxicity while not adversely impacting patient outcomes [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

De-Escalation of Therapy for Patients with Early-Stage Squamous Cell Carcinoma of the Anus

Miller

Bazan

2021

Cancers

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The incidence of squamous cell carcinoma of the anus (SCCA) is increasing, particularly in the elderly, with increased mortality in this age group. While the current standard of care for localized SCCA remains chemoradiation (CRT), completion of this treatment can be challenging with risks for severe acute and late toxicity. It remains unclear if full course CRT is required for the management of early-stage SCCA or if de-escalation of treatment is possible without compromising patient outcomes. Alternative therapies include radiation therapy alone or local excision for appropriate patients. Modifying standard CRT may also reduce toxicity including the routine use of intensity-modulated radiation therapy for treatment delivery, modification of treatment volumes, and selection and dosing of concurrent systemic therapy agents. Finally, we provide an overview of currently accruing prospective trials focused on defining the role of de-escalation of therapy in patients with early-stage SCCA.

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“…In either case the administration of concurrent chemotherapy was associated with a reduction in the risk of death (ranging from 31% to 52%). Of note, a meta-analysis of retrospective studies confirmed a worse OS with RT alone, but it found no difference in terms of DFS [41]. Another potential approach to these early stage tumours could be local excision.…”

Section: Recent Studies On Localised Anal Squamous Cell Carcinomamentioning

confidence: 99%

Anal squamous cell carcinoma: standards of care, new data and ongoing clinical trials

Giunta

Bregni

Hendlisz

et al. 2021

Current Opinion in Oncology

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Purpose of reviewTo summarize current standards of care, discuss results of recent studies and present ongoing clinical trials for anal squamous cell carcinoma (ASCC). Recent findingsOver the last year, no practice changing studies have been reported in the setting of localised ASCC. A number of retrospective analyses, however, have provided practice-informing data, such as those confirming the negative impact of low compliance to chemoradiotherapy (CRT) on patient outcomes. In contrast, and for the first time, randomized evidence has become available to inform the management of advanced tumours. The InterAACT trial represents a key milestone in the evidence-building process for this disease, establishing carboplatin plus paclitaxel as a new standard of care for treatment-naı ¨ve advanced ASCC patients. Furthermore, more data have accumulated about the value of triplet chemotherapy in the first-line setting and of immune checkpoint inhibitors (either as single agents or in combination with other agents) in the refractory setting. SummaryRecent findings have the potential to improve the treatment quality standards and overall outcome of patients with either localised or advanced ASCC. Results from ongoing clinical trials will hopefully provide useful insights into the management of this disease and further shape current treatment paradigms.

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Radiotherapy alone versus chemoradiotherapy for stage I anal squamous cell carcinoma: a systematic review and meta-analysis

Cited by 4 publications

References 55 publications

Anal Carcinoma, Version 2.2023, NCCN Clinical Practice Guidelines in Oncology

Anal Carcinoma, Version 2.2023, NCCN Clinical Practice Guidelines in Oncology

De-Escalation of Therapy for Patients with Early-Stage Squamous Cell Carcinoma of the Anus

Anal squamous cell carcinoma: standards of care, new data and ongoing clinical trials

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