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Techniques in Coloproctology

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Open Access 01-09-2021 | Human Papillomavirus | Original Article

Local excision and treatment of early node-negative anal squamous cell carcinomas in a highly HIV prevalent population

Authors: D. R. L. Brogden, C. Kontovounisios, I. Chong, D. Tait, O. J. Warren, M. Bower, P. Tekkis, S. C. Mills

Published in: Techniques in Coloproctology | Issue 9/2021

Abstract

Background

Anal squamous cell carcinoma (ASCC) is an uncommon cancer associated with human immunodeficiency virus (HIV) infection. There has been increasing interest in providing organ-sparing treatment in small node-negative ASCC’s, however, there is a paucity of evidence about the use of local excision alone in people living with HIV (PLWH). The aim of this study was to evaluate the efficacy of local excision alone in this patient population.

Methods

We present a case series of stage 1 and stage 2 ASCC in PLWH and HIV negative patients. Data were extracted from a 20-year retrospective cohort study analysing the treatment and outcomes of patients with primary ASCC in a cohort with a high prevalence of HIV.

Results

Ninety-four patients were included in the analysis. Fifty-seven (61%) were PLWH. Thirty-five (37%) patients received local excision alone as treatment for ASCC, they were more likely to be younger (p = 0.037, ANOVA) and have either foci of malignancy or well-differentiated tumours on histology (p = 0.002, Fisher’s exact test).

There was no statistically significant difference in 5-year disease-free survival and recurrence between treatment groups, however, patients who had local excision alone and PLWH were both more likely to recur later compared to patients who received other treatments for ASCC. (72.3 months vs 27.3 months, p = 0.06, ANOVA, and 72.3 months vs 31.8 months, p = 0.035, ANOVA, respectively).

Conclusions

We recommend that local excision be considered the sole treatment for stage 1 node-negative tumours that have clear margins and advantageous histology regardless of HIV status. However, PLWH who have local excision alone must have access to an expert long-term surveillance programme after treatment to identify late recurrences.

Cancer AJCo (2018) Cancer staging manual 8th edition. Cancer staging. https://cancerstaging.org/references-tools/deskreferences/Pages/8EUpdates.aspx#. Accessed 27/08/2018 2018

Myint AS (2011) Follow up. Colorectal Dis 13(Suppl 1):39–43. https://doi.org/10.1111/j.1463-1318.2010.02499.xCrossRefPubMed

James RD, Glynne-Jones R, Meadows HM, Cunningham D, Myint AS, Saunders MP, Maughan T, McDonald A, Essapen S, Leslie M, Falk S, Wilson C, Gollins S, Begum R, Ledermann J, Kadalayil L, Sebag-Montefiore D (2013) Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2 × 2 factorial trial. Lancet Oncol 14(6):516–524. https://doi.org/10.1016/s1470-2045(13)70086-xCrossRefPubMed

Islami F, Ferlay J, Lortet-Tieulent J, Bray F, Jemal A (2017) International trends in anal cancer incidence rates. Int J Epidemiol 46(3):924–938. https://doi.org/10.1093/ije/dyw276CrossRefPubMed

Lee G, Kunitake H, Stafford C, Bordeianou L, Francone TD, Ricciardi R (2018) What is the risk of anal carcinoma in patients with anal intraepithelial neoplasia? Dis Colon Rectum 61(5):e69–e70. https://doi.org/10.1097/DCR.0000000000001104CrossRef

Tong WWY, Jin F, McHugh LC, Maher T, Sinclair B, Grulich AE, Hillman RJ, Carr A (2013) Progression to and spontaneous regression of high-grade anal squamous intraepithelial lesions in HIV-infected and uninfected men. AIDS 27(14):2233–2243. https://doi.org/10.1097/QAD.0b013e3283633111CrossRefPubMed

Scholefield JH, Harris D, Radcliffe A (2011) Guidelines for management of anal intraepithelial neoplasia. Colorectal Dis 13(Suppl 1):3–10. https://doi.org/10.1111/j.1463-1318.2010.02494.xCrossRefPubMed

Fuchs W, Wieland U, Skaletz-Rorowski A, Brockmeyer NH, Swoboda J, Kreuter A, Michalik C, Potthoff A, Competence Network for HA (2016) The male ScreenING study: prevalence of HPV-related genital and anal lesions in an urban cohort of HIV-positive men in Germany. J Eur Acad Dermatol Venereol 30(6):995–1001. https://doi.org/10.1111/jdv.13539CrossRef

Geh I, Gollins S, Renehan A, Scholefield J, Goh V, Prezzi D, Moran B, Bower M, Alfa-Wali M, Adams R (2017) Association of coloproctology of great Britain & Ireland (ACPGBI): guidelines for the management of cancer of the colon, rectum and anus (2017)—anal cancer. Colorectal Dis 19(Suppl 1):82–97. https://doi.org/10.1111/codi.13709CrossRefPubMed

10.

Stewart DB, Gaertner WB, Glasgow SC, Herzig DO, Feingold D, Steele SR, Prepared on Behalf of the Clinical Practice Guidelines Committee of the American Society of C, Rectal S (2018) The American society of colon and rectal surgeons clinical practice guidelines for anal squamous cell cancers (revised 2018). Dis Colon Rectum 61(7):755–774. https://doi.org/10.1097/DCR.0000000000001114CrossRef

11.

Insitute NYSDoHA (2020) Screening for anal dysplasia and cancer in patients with HIV. New York state department of health AIDS institute. https://www.hivguidelines.org/hiv-care/anal-dysplasia-cancer/#tab_0. Accessed 17/12/2020 2020

12.

Esser S, Kreuter A, Oette M, Gingelmaier A, Mosthaf F, Sautter-Bihl ML, Jongen J, Brockmeyer NH, Eldering G, Swoboda J, Postel N, Degen O, Schalk H, Jessen A, Knechten H, Thoden J, Stellbrink HJ, Schafberger A, Wieland U (2015) German-Austrian guidelines on anal dysplasia and anal cancer in HIV-positive individuals: prevention, diagnosis, and treatment. JDDG-J German Soc Dermatol 13(12):1302–1319. https://doi.org/10.1111/ddg.12726CrossRef

13.

Reid E, Suneja G, Ambinder RF, Ard K, Baiocchi R, Barta SK, Carchman E, Cohen A, Gupta N, Johung KL, Klopp A, LaCasce AS, Lin C, Makarova-Rusher OV, Mehta A, Menon MP, Morgan D, Nathwani N, Noy A, Palella F, Ratner L, Rizza S, Rudek MA, Taylor J, Tomlinson B, Wang CJ, Dwyer MA, Freedman-Cass DA (2018) Cancer in people living with HIV, version 1.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 16(8):986–1017. https://doi.org/10.6004/jnccn.2018.0066CrossRefPubMed

14.

Giani I, Mistrangelo M, Fucini C, Italian Society of Colo-Rectal S (2013) The treatment of squamous anal carcinoma: guidelines of the Italian society of colo-rectal surgery. Tech Coloproctol 17(2):171–179. https://doi.org/10.1007/s10151-012-0912-8CrossRef

15.

Brogden DRL, Khoo CC, Kontovounisios C, Pellino G, Chong I, Tait D, Warren OJ, Bower M, Tekkis P, Mills SC (2021) Anal squamous cell carcinoma in a high HIV prevalence population. Discover Oncol 12(1):3. https://doi.org/10.1007/s12672-021-00397-7CrossRef

16.

registry I (2020) PLATO—Personalising anal cancer radiotherapy dose. Spinger Nature. https://www.isrctn.com/ISRCTN88455282. Accessed 15/04/2021 2021

17.

Chai CY, Tran Cao HS, Awad S, Massarweh NN (2018) Management of stage I squamous cell carcinoma of the anal canal. JAMA Surg 153(3):209–215. https://doi.org/10.1001/jamasurg.2017.3151CrossRefPubMed

18.

Gao X, Goffredo P, Kahl AR, Charlton ME, Weigel RJ, Hassan I (2020) Chemoradiation versus local excision in treatment of stage I anal squamous cell carcinoma: a population-based analysis. Eur J Surg Oncol 46(9):1663–1667. https://doi.org/10.1016/j.ejso.2020.03.003CrossRefPubMedPubMedCentral

19.

Maccabe TA, Parwaiz I, Longman RJ, Thomas MG, Messenger DE (2020) Outcomes following local excision of early anal squamous cell carcinomas of the anal canal and perianal margin. Colorectal Dis. https://doi.org/10.1111/codi.15424CrossRefPubMedPubMedCentral

20.

Chakrabarti S, Jin Z, Huffman BM, Yadav S, Graham RP, Lam-Himlin DM, Lightner AL, Hallemeier CL, Mahipal A (2019) Local excision for patients with stage I anal canal squamous cell carcinoma can be curative. J Gastrointest Oncol 10(2):171–178. https://doi.org/10.21037/jgo.2018.12.12CrossRefPubMedPubMedCentral

21.

Boman BM, Moertel CG, O’Connell MJ, Scott M, Weiland LH, Beart RW, Gunderson LL, Spencer RJ (1984) Carcinoma of the anal canal. A clinical and pathologic study of 188 cases. Cancer 54(1):114–125CrossRefPubMed

22.

Klas JV, Rothenberger DA, Wong WD, Madoff RD (1999) Malignant tumors of the anal canal: the spectrum of disease, treatment, and outcomes. Cancer 85(8):1686–1693. https://doi.org/10.1002/(sici)1097-0142(19990415)85:8%3c1686::aid-cncr7%3e3.0.co;2-7CrossRefPubMed

23.

Alfa-Wali M, Safarfashandi L, Ion L, Nelson M, Allen-Mersh T, Bower M (2013) Salvage surgery for residual primary anal squamous cell carcinoma after chemoradiotherapy in HIV-positive individuals. HIV Med 2:28. https://doi.org/10.1111/hiv.12027CrossRef

24.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, for the SI (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4(10):e296. https://doi.org/10.1371/journal.pmed.0040296CrossRef

25.

Darragh TM, Colgan TJ, Thomas Cox J, Heller DS, Henry MR, Luff RD, McCalmont T, Nayar R, Palefsky JM, Stoler MH, Wilkinson EJ, Zaino RJ, Wilbur DC (2013) 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. Int J Gynecol Pathol 32(1):76–115. https://doi.org/10.1097/PGP.0b013e31826916c7CrossRefPubMed

26.

Gouvas N, Gourtsoyianni S, Kalogeridi MA, Sougklakos J, Vini L, Xynos E (2020) Hellenic society of medical oncology (HESMO) guidelines for the management of anal cancer. Updates Surg. https://doi.org/10.1007/s13304-020-00923-2CrossRefPubMed

27.

Cappello C, Cuming T, Bowring J, Rosenthal AN, Chindawi N, Nathan M (2020) High resolution anoscopy surveillance after anal squamous cell carcinoma: high-grade squamous intraepithelial lesion detection and treatment may influence local recurrence. Dis Colon Rectum. https://doi.org/10.1097/dcr.0000000000001750CrossRefPubMedPubMedCentral

Title: Local excision and treatment of early node-negative anal squamous cell carcinomas in a highly HIV prevalent population
Authors: D. R. L. Brogden
C. Kontovounisios
I. Chong
D. Tait
O. J. Warren
M. Bower
P. Tekkis
S. C. Mills
Publication date: 01-09-2021
Publisher: Springer International Publishing
Keywords: Human Papillomavirus
Human Immunodeficiency Virus
Published in: Techniques in Coloproctology / Issue 9/2021
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-021-02473-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Local excision and treatment of early node-negative anal squamous cell carcinomas in a highly HIV prevalent population

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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