Twenty-year experience in the management of squamous cell anal canal carcinoma with interstitial brachytherapy

Guerra, José Luis López; Lozano, A.; Pera, J.; Gutiérrez, Cristina; Cambray, M.; Ferrer, Ferran; Guedea, Ferrán

doi:10.1007/s12094-011-0684-z

Cited by 10 publications

(5 citation statements)

References 27 publications

(30 reference statements)

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“…Squamous cell anal cancer is a rare tumour which represents 1.5% of gastrointestinal cancers, but in Slovenia only 0.5%. 1 – 5 Despite its infrequent occurrence its incidence is increasing. 4 Women are more commonly affected than men.…”

Section: Introductionmentioning

confidence: 99%

The impact of anaemia on treatment outcome in patients with squamous cell carcinoma of anal canal and anal margin

Oblak

Češnjevar

Anzic

et al. 2016

Radiology and Oncology

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BackgroundRadiochemotherapy is the main treatment for patients with squamous cell carcinoma of the anal canal. Anaemia is reported to have adverse effect on survival in cancer patients. The aim of the study was to evaluate the influence of anaemia on radiochemotherapy treatment outcome in patients with squamous cell carcinoma of the anal canal.Patients and methodsOne hundred consecutive patients with histologically confirmed squamous cell carcinoma of the anal canal were treated radically with 3-dimensional conformal or intensity-modulated radiation therapy followed by brachytherapy or external beam radiotherapy boost and with concurrent mitomycin C and 5-fluorouracil. The influence on survival of pre-treatment, mean on-treatment and end-of-treatment haemoglobin (Hb) concentrations was studied.ResultsThe 5-year locoregional control, disease free survival, disease specific survival and overall survival rates for all patients were 72%, 71%, 77% and 62%, respectively. In univariate analysis, patients with pre-treatment and end-of-treatment Hb > 120 g/L survived statistically significantly better compared to patients with Hb ≤ 120 g/L. Patients with mean on-treatment Hb > 120 g/L only had statistically significant better locoregional control and overall survival than patients with Hb ≤ 120 g/L. In multivariate analysis, independent prognostic factors were pre-treatment Hb (> 120 g/L vs. ≤ 120 g/L) for overall survival (hazard ratio [HR] = 0.419, 95% confidence interval [CI] = 0.190–0.927, p = 0.032) and stage (I & II vs. III) for disease specific (HR = 3.523, 95% CI = 1.375–9.026, p = 0.009) and overall survival (HR = 2.230, 95% CI = 1.167–4.264, p = 0.015).ConclusionsThe pre-treatment, mean on-treatment and end-of-treatment Hb concentration > 120 g/L carried better prognosis for patients for with squamous cell carcinoma of the anal canal treated with radiochemotherapy. The pre-treatment Hb > 120 g/L was an independent prognostic factor for overall survival of patients with anal canal cancer.

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Section: Introductionmentioning

confidence: 99%

The impact of anaemia on treatment outcome in patients with squamous cell carcinoma of anal canal and anal margin

Oblak

Češnjevar

Anzic

et al. 2016

Radiology and Oncology

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“…A historical clinical study published by Papillon et al [ 9 ] focusing on LDR brachytherapy showed a 69.2% OS rate at 3 years. More recent PDR studies from Gerard et al [ 20 ] and Bruna et al [ 21 ] found respectively an OS rate of 100% at 1 year and 90% at 2 years. Lòpez Guerrera et al [ 22 ] presented a mixed study of LDR and PDR brachytherapy with a 2-year OS rate of 87%.…”

Section: Discussionmentioning

confidence: 99%

Interstitial high-dose rate brachytherapy as boost for anal canal cancer

et al. 2014

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AimTo assess clinical outcomes of patients treated with a high-dose rate brachytherapy boost for anal canal cancer (ACC).MethodsFrom August 2005 to February 2013, 28 patients presenting an ACC treated by split-course external beam radiotherapy (EBRT) and HDR brachytherapy with or without chemotherapy in a French regional cancer center in Nice were retrospectively analyzed.ResultsMedian age was 60.6 years [34 – 83], 25 patients presented a squamous cell carcinoma and 3 an adenocarcinoma; 21 received chemotherapy. Median dose of EBRT was 45 Gy [43.2 – 52]. Median dose of HDR brachytherapy was 12 Gy [10 - 15] with a median duration of 2 days. Median overall treatment time was 63 days and median delay between EBRT and brachytherapy was 20 days. Two-year local relapse free, metastatic free, disease free and overall survivals were 83%, 81.9%, 71.8% and 87.7% respectively. Acute toxicities were frequent but not severe with mostly grade 1 toxicities: 37% of genito-urinary, 40.7% of gastro-intestinal and 3.7% of cutaneous toxicities. Late toxicities were mainly G1 (43.1%) and G2 (22%). Two-year colostomy-free survival was 75.1%, one patient had a definitive sphincter amputation.ConclusionHigh-dose rate brachytherapy for anal canal carcinoma as boost represents a feasible technique compared to low or pulsed-dose rate brachytherapy. This technique remains an excellent approach to precisely boost the tumor in reducing the overall treatment time.

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“…It arises most commonly from the squamous epithelium in the distal half of the anal canal, with a minority originating from the transitional zone mucosa [6]. Although it currently comprises only approximately 4% of gastrointestinal tract malignancies, the incidence is slowly increasing; current data shows the incidence to be 0.7 per 100,000 per year [1, 2, 6, 7]. The exact reason for this increase is unknown, but hypotheses include increases in the number of patients taking immune-suppressing medications for organ transplants or other disorders, and an increase in immune-suppressing diseases such as HIV/AIDS [1].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of anal carcinomas are squamous cell carcinomas (SCCs) for which the treatment has been well-established and the prognosis is usually favorable [2]. The rate of metastatic disease is low and is typical to either the liver or the lungs.…”

Section: Introductionmentioning

confidence: 99%

Development of Cerebral Metastasis after Medical and Surgical Treatment of Anal Squamous Cell Carcinoma

Gassman

Fernando

Holmes

et al. 2012

Case Reports in Oncological Medicine

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Squamous cell carcinoma of the anus is a relatively uncommon GI malignancy. When it does occur, it metastasizes in only a small minority of patients. Spread of anal squamous cell carcinoma to the brain is exceedingly rare, and has been previously reported only three times in the medical literature. We report the case of a 67 year old male who was diagnosed on presentation with a poorly differentiated anal squamous cell carcinoma that already had a solitary metastasis to the liver. While the tumors were initially responsive to chemoradiotherapy, the patient's primary and liver lesions recurred. The patient then underwent synchronous abdominoperineal resection for the primary lesion and a liver lobectomy for the metastasis. Soon thereafter, the patient developed focal neurologic symptoms and was found to have an intracranial lesion that on biopsy demonstrated metastatic squamous cell carcinoma. This case highlights the fact that patients with a previous history of anal squamous cell carcinoma can occasionally develop cerebral metastasis. Furthermore, cerebral metastases from anal squamous cell carcinoma portend a dismal prognosis even in the face of aggressive medical and surgical therapy.

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Twenty-year experience in the management of squamous cell anal canal carcinoma with interstitial brachytherapy

Abstract: Interstitial brachytherapy appears to be an effective and well tolerated treatment for anal carcinoma offering both high local tumour control and anal sphincter preservation.

Cited by 10 publications

References 27 publications

The impact of anaemia on treatment outcome in patients with squamous cell carcinoma of anal canal and anal margin

The impact of anaemia on treatment outcome in patients with squamous cell carcinoma of anal canal and anal margin

Interstitial high-dose rate brachytherapy as boost for anal canal cancer

Development of Cerebral Metastasis after Medical and Surgical Treatment of Anal Squamous Cell Carcinoma

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