Document Detail


Radiotherapy with or without chemotherapy in the treatment of anal cancer: 20-year experience from a single institute.
MedLine Citation:
PMID:  23149618     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
K Fakhrian; T Sauer; S Klemm; C Bayer; B Haller; M Molls; H Geinitz
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-15
Journal Detail:
Title:  Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]     Volume:  -     ISSN:  1439-099X     ISO Abbreviation:  Strahlenther Onkol     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8603469     Medline TA:  Strahlenther Onkol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Klinikum rechts der Isar, Technische Universität München, Munich, Germany, khfmed@yahoo.com.
Vernacular Title:
Strahlentherapie mit oder ohne Chemotherapie bei der Behandlung des Analkarzinoms: 20-jährige Erfahrungen einer Klinik.
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