Carcinoma of the Anal Canal

Myerson, Robert J.; Shapiro, Susan J.; López, Marvin J.; Birnbaum, Elisa H.; Fleshman, James W.; Fry, Robert D.; Kodner, Ira J.

doi:10.1097/00000421-199502000-00007

Cited by 34 publications

(19 citation statements)

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“…This is consistent with the hypothesis that 30 Gy is adequate for microscopic disease, which is further supported by a recent series in which 30 Gy seemed to be an effective dose in patients with anal cancer treated by excisional biopsy followed by CRT (Hu et al, 1999). However, there is evidence that 30 Gy is inadequate for control of macroscopic disease (Myerson et al, 1995). In this retrospective series, the local control rate for T2/3 patients treated to 30 Gy was 63%, compared to 77% for a dose of 40 -50 Gy.…”

Section: Discussionsupporting

confidence: 87%

Concurrent chemoradiotherapy for squamous cell carcinoma of the anus using a shrinking field radiotherapy technique without a boost

Melcher

Sebag‐Montefiore

2003

Br J Cancer

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Chemoradiotherapy (CRT) is now widely accepted as the primary treatment modality for squamous cell cancer of the anus. While randomised trials have clearly shown CRT to be more effective than radiotherapy alone, there remains uncertainty over the optimal integration of chemotherapy and radiation. We describe a series of 50 patients treated by a site specialist gastrointestinal nonsurgical oncologist with CRT at a single UK centre. Chemotherapy comprised mitomycin C (MMC) (day 1) and 5-fluorouracil (5-FU) (days 1 -4, and 29 -32), concurrent with 50 Gy in 25 fractions radiation, using a two-phase shrinking field technique. A radiation boost was not planned. At a median follow-up of 48 months, 11 (22%) of the patients have failed locally, of which three have been surgically salvaged. Nine (18%) have died of anal cancer. These results are comparable with those from large randomised studies, and suggest that a two-phase shrinking field radiotherapy technique with no boost, concurrent with MMC/5-FU chemotherapy, is an effective regimen for this disease. The CRT regimen described here provides the basis for the 'control arm' of the current UK-randomised CRT trial in anal cancer (ACT2).

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Section: Discussionsupporting

confidence: 87%

Concurrent chemoradiotherapy for squamous cell carcinoma of the anus using a shrinking field radiotherapy technique without a boost

Melcher

Sebag‐Montefiore

2003

Br J Cancer

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“…Local control was significantly related to RT dose 155 Gy in both univariate and multivariate analysis in 57 patients reviewed by Nigh et al [37]; as salvage was effective, better local control did not translate into longer survival. An improved CFS was reported by Myerson et al [24] for T 2-3 patients receiving 40-50 Gy compared with 30 Gy only; higher local control was achieved for a dose 160 Gy in another small series [38]. Smith et al [39] reported a failure rate of 62% in stage T 3-4 tumors using CRT with 30 Gy; on the contrary, T 1-2 lesions were adequately controlled with this protocol.…”

Section: Discussionmentioning

confidence: 69%

“…Combined chemoradiotherapy (CRT), first reported by Nigro et al [15], has been widely used to improve survival and sphincter preservation. Local control in 65-90% of cases and 5-year disease-free survival (DFS) in 60-80% have been reported, with preservation of anal function in about 65-80% of patients [16][17][18][19][20][21][22][23][24]. CRT has gained therefore general acceptance as the standard treatment [25].…”

Section: Introductionmentioning

confidence: 99%

Role of Dose Intensity in Conservative Treatment ofAnal Canal Carcinoma

Ceresoli¹,

Ferreri²,

Cordio³

et al. 1998

Oncology

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Chemoradiotherapy (CRT) is considered the standard treatment for anal canal cancer. However, the optimum schedule of therapy has yet to be defined. This study was carried out to evaluate the role of dose intensity (DI) of chemotherapy (ChT) and radiotherapy (RT) on the outcome of patients submitted to CRT. Thirty-five consecutive patients with anal canal carcinoma received a combination of RT (median dose 56 Gy) and ChT (two or more cycles of 5-fluorouracil and mitomycin C). With a median follow-up of 33 months, 83% of patients are alive without evidence of disease and 70% are colostomy-free. Five-year actuarial disease-free survival (DFS) is 74%. Univariate and multivariate analysis was performed to determine the correlation of DFS with various clinical and therapeutic parameters. Our series confirmed the prognostic negative value of a tumor size >4 cm. An average relative dose-intensity (ARDI) >0.8 was related to a better outcome both in univariate and in multivariate analysis; an overall treatment time >70 days was related to a worse DFS in univariate analysis, but these data were not confirmed by the Cox model. RT dose was not associated with DFS. In conclusion, the results of this study seem to suggest an independent prognostic role of ChT DI, as measured by ARDI. The results regarding RT DI are inconclusive, and remain a matter for further trials.

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“…About half were lung cancer (17 CMT vs 7 RT alone), which may reflect the shared role of smoking in the aetiology of anal cancer and lung cancer (Frisch et al, 1999;Daling et al, 2004). An excess of second malignancies has also been noted after administration of alkylating agents such as mitomycin C (Myerson et al, 1995), although the effect is not consistently seen across studies (Zakotnik et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I)

et al. 2010

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demonstrated the benefit of chemoradiation over radiotherapy (RT) alone for treating epidermoid anal cancer, and it became the standard treatment. Patients in this trial have now been followed up for a median of 13 years. METHODS: A total of 577 patients were randomised to receive RT alone or combined modality therapy using 5-fluorouracil and mitomycin C. All patients were scheduled to receive 45 Gy by external beam irradiation. Patients who responded to treatment were recommended to have boost RT, with either an iridium implant or external beam irradiation. Data on relapse and deaths were obtained until October 2007. RESULTS: Twelve years after treatment, for every 100 patients treated with chemoradiation, there are an expected 25.3 fewer patients with locoregional relapse (95% confidence interval (CI): 17.5 -32.0 fewer) and 12.5 fewer anal cancer deaths (95% CI: 4.3 -19.7 fewer), compared with 100 patients given RT alone. There was a 9.1% increase in non-anal cancer deaths in the first 5 years of chemoradiation (95% CI þ 3.6 to þ 14.6), which disappeared by 10 years. CONCLUSIONS: The clear benefit of chemoradiation outweighs an early excess risk of non-anal cancer deaths, and can still be seen 12 years after treatment. Only 11 patients suffered a locoregional relapse as a first event after 5 years, which may influence the choice of end points in future studies.

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Carcinoma of the Anal Canal

Cited by 34 publications

References 0 publications

Concurrent chemoradiotherapy for squamous cell carcinoma of the anus using a shrinking field radiotherapy technique without a boost

Concurrent chemoradiotherapy for squamous cell carcinoma of the anus using a shrinking field radiotherapy technique without a boost

Role of Dose Intensity in Conservative Treatment ofAnal Canal Carcinoma

Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I)

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