Squamous-cell Carcinoma of the Anal Canal: Predictors of Treatment Outcome

Roohipour, Ramin; Patil, Sujata; Goodman, Karyn A.; Minsky, Bruce D.; Wong, W. Douglas; Guillem, José G.; Paty, Philip B.; Weiser, Martin R.; Neuman, Heather B.; Shia, Jinru; Schrag, Deborah; Temple, Larissa K.

doi:10.1007/s10350-007-9125-z

Cited by 108 publications

(67 citation statements)

References 25 publications

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“…T1 tumors of the anal canal are not subdivided further. Combined modality therapy is the current primary therapy and standard of care for anal SCC but also has associated morbidity [153]. Historically, patients with small cancers excised with clean margins have had good outcomes [150,151].…”

Section: Site-specific Recommendationsmentioning

confidence: 99%

The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology

Darragh

Colgan

Cox

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

643

372

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The terminology for human papillomavirus (HPV)–associated squamous lesions of the lower anogenital tract has a long history marked by disparate diagnostic terms derived from multiple specialties. It often does not reflect current knowledge of HPV biology and pathogenesis. A consensus process was convened to recommend terminology unified across lower anogenital sites. The goal was to create a histopathologic nomenclature system that reflects current knowledge of HPV biology, optimally uses available biomarkers, and facilitates clear communication across different medical specialties. The Lower Anogenital Squamous Terminology (LAST) Project was cosponsored by the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology and included 5 working groups; 3 work groups performed comprehensive literature reviews and developed draft recommendations. Another work group provided the historical background and the fifth will continue to foster implementation of the LAST recommendations. After an open comment period, the draft recommendations were presented at a consensus conference attended by LAST work group members, advisors, and representatives from 35 stakeholder organizations including professional societies and government agencies. Recommendations were finalized and voted on at the consensus meeting. The final, approved recommendations standardize biologically relevant histopathologic terminology for HPV-associated squamous intraepithelial lesions and superficially invasive squamous carcinomas across all lower anogenital tract sites and detail the appropriate use of specific biomarkers to clarify histologic interpretations and enhance diagnostic accuracy. A plan for disseminating and monitoring recommendation implementation in the practicing community was also developed. The implemented recommendations will facilitate communication between pathologists and their clinical colleagues and improve accuracy of histologic diagnosis with the ultimate goal of providing optimal patient care.

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Section: Site-specific Recommendationsmentioning

confidence: 99%

The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology

Darragh

Colgan

Cox

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

643

372

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“…The published literature suggests that treatment breaks are associated with inferior local control and survival for anal cancer patients [10,29]. Four patients in our study had a break, receiving a median total GTV dose of 59 Gy (range, 50-61 Gy).…”

Section: Discussionmentioning

confidence: 90%

Outcomes of anal cancer treated with definitive IMRT-based chemoradiation

et al. 2012

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Objective Despite excellent long-term outcomes, definitive chemoradiation (CRT) for squamous cell carcinoma (SqCC) of the anal canal with traditional radiotherapy techniques results in significant morbidity. Accruing data supports intensity-modulated radiotherapy (IMRT)-based treatment, and we report our institutional experience using this approach. Methods We reviewed patients with nonmetastatic anal canal SqCC treated with definitive IMRT-CRT. Clinically node-negative patients initially received 36 Gy to the elective pelvic and inguinal lymph nodes and 40 Gy to gross tumor volume (GTV) while node-positive patients received 45 and 50 Gy, respectively. All patients were considered for a GTV boost depending on the degree of clinical response and acute treatment-related toxicity.Results We identified 52 patients with T1-4N0-3M0 SqCC of the anal canal. Median follow-up was 21 months (range, 7.7-68.1 months). Two-year locoregional control, overall survival, disease-free survival, distant metastasis-free survival, and colostomy-free survival were 94.6, 100, 82.6, 90, and 94.7 %, respectively. Acute grade 3+ nonhematologic and hematologic toxicities were observed in 21.1 and 63.5 %, respectively. No acute grade 4 nonhematologic toxicity was observed. Conclusion Our series demonstrates that definitive IMRTbased chemoradiation with standard fractionation for anal SqCC results in excellent outcomes with minimal toxicity.

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“…The authors hypothesized that the mandated treatment break negated any benefi ts of dose escalation [18]. Similarly, a recent experience from Memorial Sloan-Kettering reported that patients with prolonged treatment breaks/protracted duration of therapy were more likely to suffer disease failure, a phenomenon confi rmed in other institutional series [19]. In this respect, the role of neoadjuvant chemotherapy preceding (and delaying) "defi nitive" RT remains unanswered.…”

Section: Chemotherapymentioning

confidence: 96%

Current management of anal canal cancer

Czito

Willett²

2009

Curr Oncol Rep

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Squamous cell carcinoma of the anal canal historically has been treated with abdominoperineal resection, resulting in high rates of morbidity and local recurrence. Pioneering work led to the finding that radiation therapy (RT) combined with 5-fluorouracil (5-FU) and mitomycin results in high rates of local control and disease-free and colostomy-free survival without surgery. Prospective randomized trials from Europe and the United States have shown the superiority of RT, 5-FU, and mitomycin over 1) RT alone, 2) RT with 5-FU, and 3) neoadjuvant cisplatin/5-FU with concurrent radiation, cisplatin, and 5-FU. At present, RT with 5-FU and mitomycin is the standard of care for anal cancer patients. Recent advances include the integration of positron emission tomography into staging, radiation treatment planning and monitoring, and the use of intensity modulated RT. European randomized trials are further evaluating the role of cisplatin in the neoadjuvant, concurrent, and adjuvant settings, as well as radiation dose escalation. Other studies are evaluating the use of capecitabine, oxaliplatin, and the anti-epidermal growth factor receptor agent cetuximab with RT in this malignancy.

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Squamous-cell Carcinoma of the Anal Canal: Predictors of Treatment Outcome

Abstract: Tolerance of chemoradiation seems to be an important predictor of treatment success. Effective therapies with less acute toxicity must be identified.

Cited by 108 publications

References 25 publications

The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology

The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology

Outcomes of anal cancer treated with definitive IMRT-based chemoradiation

Current management of anal canal cancer

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