Chemoradiation with capecitabine and mitomycin-C for locally advanced anal squamous cell carcinoma: experience of a single Portuguese institution

Abstract

All completed the first cycle of CT and 18/21 (85%) patients received 2 cycles of NACT, two with dose reduction 2/21 (9.5%). Grade 3 or higher toxicity was seen in 5/21 (23.8%); commonest was vomiting 2/21 (9.5%). Seven of 21 (33.3%) patients have completed surgery till date. Median duration from NACT end to RT start was 5.8 (1.5-22) weeks, major deviation (> 6 weeks) was seen in 3/7 (43%). Major toxicity was not seen during RT, one patient died 1 week after RT completion. 2 patients progressed on RT during 4th week. Median duration of RT was 5.8 weeks (5-6 weeks) with 1 deviation (>4 days break). Seven patients have undergone Sx, median duration of 6.2 weeks (5-7 weeks) from end of CRT to Sx. Pathological complete response (pCR) was seen in 2/7 (28% patients); 4/7 patients (57%) had ypN0. Postoperative complications were seen in 1/7 (14%) patient. Adjuvant chemotherapy, 3 cycles, was completed by 3 patients. The first 11 patients had poor compliance with 4/11(36%) lost to follow up due to finances/poor motivation and 3/11 (27%) patients had progressive disease while only 4/11 (36%) patients proceeded to Sx. The accrual rate was 1 patient /month. The latter 10 patents had quicker accrual -4 patients / month and better compliance (none lost to follow up). 3 had progression during NACT/RT, 1 patient died following RT-sudden collapse, cause unclear, 3/10 underwent surgery, 2 awaiting surgery and one could not be taken up for RT due to technical issues. Conclusion: Accrual and compliance of patients to this protocol improved over time; a learning curve was seen. Toxicity was acceptable with a pCR in2 out of 7. The protocol is doable and safe, but poor financial support, motivation and disease progression (chemo-selection) in a relatively unselected group of patients inform real-world scenarios.P À 312 The survival of patients with pancreatic cancer in Jeju Island may be related to blood type