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Strahlentherapie und Onkologie

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01-01-2013 | Original article

Radiotherapy with or without chemotherapy in the treatment of anal cancer: 20-year experience from a single institute

Authors: K. Fakhrian, MD, T. Sauer, MD, S. Klemm, MD, C. Bayer, PhD, B. Haller, M. Molls, MD, H. Geinitz, MD

Published in: Strahlentherapie und Onkologie | Issue 1/2013

Abstract

Purpose

To report the efficacy and toxicity of radio(chemo)therapy (RCT) in the management of squamous cell anal carcinoma (SQ-AC) and to evaluate the prognostic factors influencing the outcomes.

Patients and methods

A consecutive cohort of 138 patients with cT1-4, cN0-3, cM0 SQ-AC were treated with RCT between 1988 and 2011 at our department. Median follow-up time for surviving patients from the start of RCT was 98 months (range, 1–236 months). Patients were treated with a median radiation dose of 56 Gy (range, 4–61 Gy). Concurrent chemotherapy was administered to 119 patients (86%).

Results

The survival rates at 2, 5, and 10 years were 88 ± 3, 82 ± 4, and 59 ± 6%, respectively, with a median overall survival (OS) of 167 months. The cumulative incidence for local recurrence at 2 and 5 years was 8 ± 2 and 11 ± 3%, respectively. The median disease-free survival (DFS) and colostomy-free survival (CFS) times were 132 and 135 months, respectively. In 19 patients (14%), a distant metastasis was diagnosed after a median time of 19 months. In the multivariate analysis, UICC (International Union Against Cancer) stage I-II, female gender, Eastern Cooperative Oncology Group (ECOG) performance status of 0–1, and good/moderate histologic differentiation (G1–2) were significantly associated with a better OS, DFS, and CFS. Conformal radiotherapy planning techniques were significantly associated with a lower cumulative incidence of local recurrence (11 ± 3% vs. 38 ± 19% at 5 years, p = 0.006). A higher radiation dose beyond 54 Gy was not associated with an improvement in outcome, neither for smaller—(T1/T2) nor for larger tumors (T3/T4).

Conclusion

RCT leads to excellent outcomes—especially in patients with stage I/II and G1/G2 tumors—with acceptable toxicity. The probable advantages of high-dose radiotherapy should be considered carefully against the risk of a higher rate of toxicity. Future studies are needed to investigate the role of a more intensified (systemic) treatment for patients with unfavorable prognostic factors such as T3/T4, N+, and/or poor cell differentiation.

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Title: Radiotherapy with or without chemotherapy in the treatment of anal cancer: 20-year experience from a single institute
Authors: K. Fakhrian, MD
T. Sauer, MD
S. Klemm, MD
C. Bayer, PhD
B. Haller
M. Molls, MD
H. Geinitz, MD
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Strahlentherapie und Onkologie / Issue 1/2013
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-012-0236-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Radiotherapy with or without chemotherapy in the treatment of anal cancer: 20-year experience from a single institute

Abstract

Purpose

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Patients and methods

Results

Conclusion

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