PURPOSE
This study was designed to assess the long-term results following radiochemotherapy in patients with anal squamous-cell carcinoma and to evaluate the impact of tumor location on response, survival, and colostomy-free survival.
PATIENTS AND METHODS
Between 1985 and 2001, a total of 101 patients with anal carcinoma were registered for curative treatment, of whom 77 had involvement of the anal canal alone, 10 cases had extension into the perianal skin, and 14 patients had pure anal margin tumors. Small tumors of the anal margin were not included since they were treated by surgical excision only. Among the 101 patients were 74 women and 27 men with a median age of 62 (range, 26–84) years. T categories (International Union against Cancer) were T1 (15), T2 (36), T3 (34), and T4 (16). Seventy-one patients had no evidence of nodal disease, whereas 30 presented with involved regional nodes. Radiation treatment was directed to the primary tumor region and to the inguinal, perirectal, and internal iliac nodes using a three-field to four-field box technique with 10MV photons up to a total dose of 5040 cGy. Lesions greater than 5 cm received an additional boost by interstitial or external radiation depending on circumferential extension of the residual tumor. All patients were scheduled for simultaneous chemotherapy with two cycles of 5-fluorouracil at a dose of 1000 mg/m 2/day as 120 hours of continuous intravenous infusion on Days 1 to 5 and 29 to 33 and mitomycin C at 10 mg/m 2/day on Days 1 and 29. Median follow-up time was was 7.5 (range, 1–16) years.
RESULTS
Overall survival and colostomy-free survival rates for patients with anal canal cancer were 75 percent and 87 percent at five years, respectively. Patients with anal margin cancer had a less favorable outcome with five-year-overall and colostomy-free survival rates of 54 percent and 69 percent, respectively. After correction for imbalance between anal canal and anal margin tumors, i.e., exclusion of T1 tumors of the anal canal, difference in overall survival remained significant (73 percent vs. 54 percent, P = 0.01). Following multivariate analysis, tumor location (anal canal vs. anal margin, P = 0.02), age (P = 0.003), and dose intensity of chemotherapy (≤75 percent vs. >75 percent, P = 0.03) remained independent significant factors for overall survival. Initial tumor response at six weeks (P = 0.03) was predictive for colostomy-free survival.
CONCLUSIONS
With colostomy-free survival rates around 85 percent, long-term treatment results for anal canal carcinoma have reached a satisfactory level. However, patients with larger lesions of the perianal skin are at high risk for locoregional recurrence and possible treatment intensification in this subgroup seems desirable.
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REFERENCES
A Allal JM Kurtz G Pipard et al. (1993) ArticleTitleChemoradiotherapy versus radiotherapy alone for anal cancer: a retrospective comparison Int J Radiat Oncol Biol Phys 27 59–66 Occurrence Handle8365944
F Eschwege P Laser A Chavy et al. (1985) ArticleTitleSquamous cell carcinoma of the anal canal: treatment by external beam irradiation Radiother Oncol 3 145–50 Occurrence Handle3920734
J Papillon (1974) ArticleTitleRadiation therapy in the management of epidermoid carcinoma of the anal region Dis Colon Rectum 17 184–7
J Papillon JF Montbaron (1987) ArticleTitleEpidermoid carcinoma of the anal canal. A series of 276 cases Dis Colon Rectum 5 324–33
D Peiffert P Bey M Pernot et al. (1997) ArticleTitleConservative treatment by irradiation of epidermoid carcinomas of the anal margin Int J Radiat Oncol Biol Phys 39 57–66 Occurrence Handle10.1016/S0360-3016(97)00316-7 Occurrence Handle9300740
M Schlienger C Krzisch F Pene et al. (1989) ArticleTitleEpidermoid carcinoma of the anal canal: treatment results and prognostic variables in a series of 242 cases Int J Radiat Oncol Biol Phys 17 1141–51 Occurrence Handle2599902
JP Wagner MA Mahe P Romestaing et al. (1994) ArticleTitleRadiation therapy in the conservative treatment of carcinoma of the anal canal Int J Radiat Oncol Biol Phys 29 17–23 Occurrence Handle8175426
ND Nigro VK Vaitkevicius B Considine (1974) ArticleTitleCombined therapy for cancer of the anal canal Dis Colon Rectum 27 763–6
BJ Cummings TJ Keane B O’Sullivan CS Wong CN Catton (1991) ArticleTitleEpidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C Int J Radiat Oncol Biol Phys 21 1115–25 Occurrence Handle1938508
GG Grabenbauer N Wolf J Dunst R Sauer (1989) ArticleTitleAnalkanalkarzinom: diagnostik-therapie-prognose Strahlenther Onkol 165 829–36 Occurrence Handle2513654
GG Grabenbauer IH Schneider FP Gall R Sauer (1993) ArticleTitleEpidermoid carcinoma of the anal canal: treatment by combined radiation and chemotherapy Radiother Oncol 27 59–62 Occurrence Handle10.1016/0167-8140(93)90045-A Occurrence Handle8327734
GG Grabenbauer M Panzer B Hültenschmidt et al. (1997) ArticleTitleCombined radiation and chemotherapy for squamous cell carcinoma of the anal canal: results and prognostic variables in a multiinstitutional series of 173 patients Radiol Oncol 31 219–27
H Bartelink F Roelofsen F Eschwege et al. (1997) ArticleTitleConcomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organisation for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups J Clin Oncol 15 2040–9 Occurrence Handle9164216
InstitutionalAuthorNameUKCCCR Anal Canal Cancer Working Party (1996) ArticleTitleEpidermoid anal cancer: results from the UKCCCR randomized trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin Lancet 348 1049–54
MS Flam M John T Pajak et al. (1996) ArticleTitleRole of mitomycin C in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study J Clin Oncol 14 2527–39 Occurrence Handle8823332
Hermanek P, Scheibe O, Spiessl B, Wagner G. UICC—TNM-klassifikation maligner tumoren. Berlin: Springer, 1992
World Health Organization. International classification of diseases for oncology. Geneva: WHO, 1990
M Klimpfinger H Hauser A Berger P Hermanek (1994) ArticleTitleAktuelle klinisch-pathologische Klassifikation von Karzinomen des Analkanals Acta Chir Austriaca 26 345–51
World Health Organization. Handbook for reporting of cancer treatment. WHO offset publication no. 48. Geneva: WHO, 1979
InstitutionalAuthorNameLENT-SOMA tables (1995) ArticleTitleTable of contents Radiother Oncol 35 17–60
EL Kaplan P Meier (1958) ArticleTitleNon parametric estimation from incomplete observations J Am Stat Assoc 53 457–81
JM Bland DG Altman (2004) ArticleTitleThe logrank test BMJ 328 1073 Occurrence Handle10.1136/bmj.328.7447.1073 Occurrence Handle15117797
DR Cox (1972) ArticleTitleRegression models and life tables J R Stat Soc B34 187–202
B Sischy (1985) ArticleTitleThe use of radiation therapy combined with chemotherapy in the management of squamous cell carcinoma of the anus Int J Radiat Oncol Biol Phys 11 1587–93 Occurrence Handle3928544
R Doci R Zucali G Monica ParticleLa et al. (1996) ArticleTitlePrimary chemoradiation therapy with fluorouracil and cisplatin for cancer of the anus: results in 35 consecutive patients J Clin Oncol 14 3121–5 Occurrence Handle8955657
JP Gerard L Ayzac D Hun et al. (1998) ArticleTitleTreatment of anal canal carcinoma with high dose radiation therapy and concomitant fluorouracil-cisplatinum. Long-term results in 95 patients Radiother Oncol 46 249–56 Occurrence Handle10.1016/S0167-8140(97)00192-8 Occurrence Handle9572617
D Peiffert M Giovannini M Ducreux et al. (2001) ArticleTitleHigh-dose radiation therapy and neoadjuvant plus concomitant chemotherapy with 5-fluorouracil and cisplatin in patients with locally advanced squamous-cell anal canal cancer: final results of a phase II study Ann Oncol 12 397–404 Occurrence Handle10.1023/A:1011107105538 Occurrence Handle11332154
DC Weber JM Kurtz AS Allal (2001) ArticleTitleThe impact of gap duration in anal canal carcinoma treated by split-course radiotherapy and concomitant chemotherapy Int J Radiat Oncol Biol Phys 50 675–80 Occurrence Handle10.1016/S0360-3016(01)01510-3 Occurrence Handle11395235
J Papillon JL Chassard (1992) ArticleTitleRespective roles of radiotherapy and surgery in the management of epidermoid carcinoma of the anal margin. Series of 57 patients Dis Colon Rectum 35 422–9 Occurrence Handle10.1007/BF02049397 Occurrence Handle1568392
B Cutuli J Fenton A Labib JP Bataini G Mathieu (1988) ArticleTitleAnal margin carcinoma: 21 cases treated at the Institute Curie by exclusive conservative radiotherapy Radiother Oncol 11 1–6 Occurrence Handle10.1016/0167-8140(88)90040-0 Occurrence Handle3344351
S Bieri AS Allal JM Kurtz (2001) ArticleTitleSphincter-conserving treatment of carcinomas of the anal margin Acta Oncol 40 29–33 Occurrence Handle10.1080/028418601750071019 Occurrence Handle11321656
GG Grabenbauer KE Matzel IH Schneider et al. (1998) ArticleTitleSphincter preservation with chemoradiation in anal canal carcinoma - abdominoperineal resection in selected cases? Dis Colon Rectum 41 441–50 Occurrence Handle9559628
JF Bosset F Roelofsen DA Morgan et al. (2003) ArticleTitleShortened irradiation scheme, continuous infusion of 5-fluorouracil and fractionation of mitomycin C in locally advanced anal carcinomas. Results of a phase II study of the European Organisation for Research and Treatment of Cancer. Radiotherapy and Gastrointestinal Cooperative Groups Eur J Cancer 39 45–51 Occurrence Handle10.1016/S0959-8049(02)00377-5 Occurrence Handle12504657
AS Allal MA Sprangers F Laurencet et al. (1999) ArticleTitleAssessment of long-term quality of life in patients with anal carcinomas treated by radiotherapy with or without chemotherapy Br J Cancer 80 1588–94 Occurrence Handle10408404
D Vordermark M Sailer M Flentje A Thiede O Kölbl (1999) ArticleTitleCurative-intent radiation therapy in anal carcinoma: quality of life and sphincter function Radiother Oncol 52 239–43 Occurrence Handle10.1016/S0167-8140(99)00096-1 Occurrence Handle10580870
RP Akbari PB Paty JG Guillem et al. (2004) ArticleTitleOncologic outcomes of salvage surgery for epidermoid carcinoma of the anus initially managed with combined modality therapy Dis Colon Rectum 47 1136–44 Occurrence Handle10.1007/s10350-004-0548-5 Occurrence Handle15164245
L Ghouti G Houvenaeghel V Moutardier et al. (2005) ArticleTitleSalvage abdominoperineal resection after failure of conservative treatment in anal epidermoid cancer Dis Colon Rectum 48 16–22 Occurrence Handle10.1007/s10350-004-0746-1 Occurrence Handle15690652
D Perara N Pathma-Nathan P Rabbitt et al. (2003) ArticleTitleSentinel node biopsy for squamous-cell carcinoma of the anus and anal margin Dis Colon Rectum 46 1027–9 Occurrence Handle10.1007/s10350-004-7276-8 Occurrence Handle12907894
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Supported by Grant No. D 15 from the Interdisciplinary Center for Clinical Research of the Medical Faculty of the University of Erlangen-Nuremberg.
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Grabenbauer, G., Kessler, H., Matzel, K. et al. Tumor Site Predicts Outcome After Radiochemotherapy in Squamous-Cell Carcinoma of the Anal Region: Long-Term Results of 101 Patients. Dis Colon Rectum 48, 1742–1751 (2005). https://doi.org/10.1007/s10350-005-0098-5
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DOI: https://doi.org/10.1007/s10350-005-0098-5