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

Abstract

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.

One Compared with Two Cycles of Mitomycin C in Chemoradiotherapy for Anal Cancer: Analysis of Outcomes and Toxicity

“…Earlier phase iii trials have used a single bolus of mmc at 12-15 mg/m 2 or 2 cycles at 10 mg/m 2 . In our study, mmc was prescribed at a lower dose of 10 mg/m 2 , but survival outcomes in the two study arms were similar [6][7][8][9][10][11] .…”

“…The ccrt regimen in trials conducted by the U.K. Co-ordinating Committee on Cancer Research (act i) and the European Organisation for Research and Treatment of Cancer used a single cycle of mmc and, compared with rt alone, demonstrated superiority in locoregional control and disease-free survival (dfs). However, no overall survival (os) benefit was found [6][7][8] . The Radiation Therapy Oncology Group (rtog) 87-04 trial similarly demonstrated significant improvements in colostomy-free survival and dfs with the addition of 2 cycles of mmc to 5fu and rt, but again, no survival benefit was observed 9 .…”

La chimiothérapie dans le traitement du carcinome épidermoïde du canal anal

“…Ses résultats ont été récemment publiés [2]. Elle confirme la supériorité de la RCT sur la RT exclusive en termes de réduction du risque de récidive locorégionale (HR = 0,46 ; IC 95 % : 0,35-0,60 ; p < 0,001 ; réduction absolue de 25,3 % à 12 ans entre les 2 groupes) et d'amélioration de la survie sans récidive (HR = 0,70 ; IC 95 % : 0,58-0,84 ; p < 0,00 ; résolution absolue de 12 % à 12 ans entre les 2 groupes) et de la survie sans colostomie (HR = 0,76 ; IC 95 % : 0,63-0,91 ; p < 0,001 ; réduction absolue de 9,5 % à 12 ans entre les 2 groupes).…”

Chemoradiation with Capecitabine and Mitomycin-C for Stage I-III Anal Squamous Cell Carcinoma

“…Treatment regimens for SCC of the anal canal have evolved over the past decades, and studies have included comparisons of radiotherapy alone versus chemoradiation [7][8][9]; determining treatment benefits of mitomycin C (MMC) [10,11]; and comparisons of MMC with cisplatin [6,[12][13][14][15]. The accepted current standard regimen for patients with stage I-III SCC of the anal canal is radiotherapy (50.4 Gy) with concurrent infusional 5-fluorouracil (5-FU) administered days one through four during weeks one and five and MMC administered on day one of week one.…”