Anal Carcinoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

Benson, Al B.; Venook, Alan P.; Al-Hawary, Mahmoud M.; Cederquist, Lynette; Chen, Yi Jen; Ciombor, Kristen K.; Cohen, Stacey A.; Cooper, Harry S.; Deming, Dustin A.; Engstrom, Paul F.; Grem, Jean L.; Grothey, Axel; Hochster, Howard S.; Hoffe, Sarah E.; Hunt, Steven R.; Kamel, Ayman H.; Kirilcuk, Natalie; Krishnamurthi, Smitha; Messersmith, Wells A.; Meyerhardt, Jeffrey A.; Mulcahy, Mary F.; Murphy, James D.; Nurkin, Steven; Saltz, Leonard; Sharma, Sunil; Shibata, David; Skibber, John M.; Sofocleous, Constantinos T.; Stoffel, Elena M.; Stotsky-Himelfarb, Eden; Willett, Christopher G.; Wuthrick, Evan; Gregory, Kristina M.; Freedman-Cass, Deborah A.

doi:10.6004/jnccn.2018.0060

Cited by 129 publications

(122 citation statements)

References 142 publications

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“…Regarding the second‐line treatment, no international consensus has so far emerged. In 2018, National Comprehensive Cancer Network Clinical Practice Guidelines added two programmed cell death protein‐1 (PD‐1) inhibitors, as option based on the encouraging results of a multicenter phase 2 and a phase 1b trials …”

Section: Introductionmentioning

confidence: 99%

Mitomycin and 5‐fluorouracil for second‐line treatment of metastatic squamous cell carcinomas of the anal canal

et al. 2019

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BackgroundMetastatic squamous cell carcinomas (SCC) of the anal canal are rare and there is no international consensus on their second‐line management. 5‐Fluorouracil (5‐FU) and mitomycin in combination with radiotherapy is the standard for locally advanced forms but its efficacy in metastatic stage has never been evaluated.Patients and methodsWe report a retrospective analysis of patients treated with 5‐FU and mitomycin from 2000 to 2017 in our institution for a metastatic SCC of the anal canal after failure of platinum‐based regimen. The main outcome was progression‐free survival (PFS) and the secondary outcomes were overall survival (OS), response rate, and toxicity.ResultsNineteen patients, 15 women and four men, with a median age of 57 years were identified (range, 40‐79 years). Patients received a median of three cycles (1‐7) of mitomycin 5‐FU. A dose reduction was necessary in six patients (31.6%), one patient had to discontinue treatment following toxicity and no death was due to treatment toxicity was reported. An objective response was observed in five patients (26.4%, 95% CI 6.6‐46.2) including one complete response, six patients (31.6%, 95% CI 10.7‐52.5) showed tumor stabilization. Median PFS and OS were 3 months [95% CI 1‐5] and 7 months [95% CI 2.2‐11.8]. Responder had a median duration of response of 4 months [95% CI 1.8‐6.1] and one patient had 23 months duration of response. No significant difference was noted for PFS and OS for patients previously treated with mitomycin and 5‐FU at a local stage.ConclusionMitomycin and 5‐FU regimen provides tumor control with acceptable tolerance. It is an option for patients with metastatic SCC of the anal canal after failure of platinum‐based chemotherapy. [Correction added on 9 October 2019, after first online publication: '5‐FU' was inadvertently removed from the Results and Conclusion and has now been added to the text.]

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Section: Introductionmentioning

confidence: 99%

Mitomycin and 5‐fluorouracil for second‐line treatment of metastatic squamous cell carcinomas of the anal canal

et al. 2019

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“…According to the guidelines of the National Comprehensive Cancer Network (NCCN, 2018), IMRT is preferred over 3D conformal RT. The anus and the perineum as well as the pelvic and inguinal LNs should be included in the target volume [19]. Although current contouring atlases refer to IMRT, the common constraints are often related to 3D conformal irradiation [20].…”

Section: Discussionmentioning

confidence: 99%

Dosimetric comparison of organs at risk using different contouring guidelines for definition of the clinical target volume in anal cancer

et al. 2020

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Background There are different contouring guidelines for definition of the clinical target volume (CTV) for intensitymodulated radiation therapy (IMRT) of anal cancer (AC). We conducted a planning comparison study to evaluate and compare the dose to relevant organs at risk (OARs) while using different CTV definitions. Methods Twelve patients with a primary diagnosis of anal cancer, who were treated with primary chemoradiation (CRT), were selected. We generated four guideline-specific CTVs and subsequently planned target volumes (PTVs) on the planning CT scan of each patient. An IMRT plan for volumetric arc therapy (VMAT) was set up for each PTV. Dose parameters of the planned target volume (PTV) and OARs were evaluated and compared, too. Results The mean volume of the four PTVs ranged from 2138 cc to 2433 cc. The target volumes contoured by the authors based on the recommendations of each group were similar in the pelvis, while they differed significantly in the inguinal region. There were no significant differences between the four target volumes with regard to the dose parameters of the cranially located OARs. Conversely, some dose parameters concerning the genitals and the skin varied significantly among the different guidelines. Conclusion The four contouring guidelines differ significantly concerning the inguinal region. In order to avoid inguinal recurrence and to protect relevant OARs, further investigations are needed to generate uniform standards for definition of the elective clinical target volume in the inguinal region.

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“…Since the 1970s, the standard treatment has consisted of a combination of 5-fluorouracil (5FU) with mitomycin C or cisplatin and radiotherapy 2,3 . Despite this treatment being very effective for early-stage tumors, the disease-free survival (DFS) rate in T3-T4 or N+ tumors ranges between 40-70% 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Comprehensive characterization of the mutational landscape in localized anal squamous cell carcinoma

Trilla-Fuertes¹,

Ghanem

Maurel

et al. 2019

Preprint

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PurposeAnal squamous cell carcinoma (ASCC) is a rare neoplasm. Chemo-radiotherapy is the standard of care, with no therapeutic advances achieved over the past three decades. Thus, a deeper molecular characterization of this disease is still necessary.MethodsWe analyzed 46 paraffin-embedded tumor samples from patients diagnosed with primary ASCC by exome sequencing. A bioinformatics approach focused in the identification of high impact genetic variants, which may act as drivers of oncogenesis, was performed. The relation between genetics variant and prognosis was also studied.ResultsThe list of high impact genetic variants was unique for each patient. However, the pathways in which these genes are involved are well-known hallmarks of cancer, such as angiogenesis or immune pathways. Additionally, we determined that genetic variants in BRCA2, ZNF750, FAM208B, ZNF599 and ZC3H13 genes are related with poor disease-free survival in ASCC.ConclusionHigh impact genetic variants in ASCC affect pathways involved in cancer development, and may play a role in the etiology of the disease. Variants in BRCA2, ZNF750, FAM208B, ZNF599 and ZC3H13 genes seem to be related with prognosis in ASCC. Sequencing of ASCC clinical samples appears an encouraging tool for the molecular portrait of this disease.

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Anal Carcinoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

Cited by 129 publications

References 142 publications

Mitomycin and 5‐fluorouracil for second‐line treatment of metastatic squamous cell carcinomas of the anal canal

Mitomycin and 5‐fluorouracil for second‐line treatment of metastatic squamous cell carcinomas of the anal canal

Dosimetric comparison of organs at risk using different contouring guidelines for definition of the clinical target volume in anal cancer

Comprehensive characterization of the mutational landscape in localized anal squamous cell carcinoma

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