Combined therapy for cancer of the anal canal

Buroker, T.; Nigro, N; Bradley, G.; Pelok, Larry R.; Chomchai, Chairat; Considine, Basil; Vaitkevicius, Vainutis K.

doi:10.1007/bf02586688

Cited by 86 publications

(22 citation statements)

References 2 publications

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“…The surgical specimens of two patients showed no evidence of residual disease, whereas a third patient refused surgery and remained disease-free. Further experience from this group and other investigators reported similar high rates of clinical and pathologic response using preoperative chemoradiotherapy and surgery [3][4][5][6][7]. These results led to multiple phase 2 trials evaluating RT alone or combined chemoradiotherapy as "defi nitive" therapy.…”

Section: Anal Canal Squamous Cell Carcinoma: the Pastmentioning

confidence: 63%

Current management of anal canal cancer

Czito

Willett²

2009

Curr Oncol Rep

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Squamous cell carcinoma of the anal canal historically has been treated with abdominoperineal resection, resulting in high rates of morbidity and local recurrence. Pioneering work led to the finding that radiation therapy (RT) combined with 5-fluorouracil (5-FU) and mitomycin results in high rates of local control and disease-free and colostomy-free survival without surgery. Prospective randomized trials from Europe and the United States have shown the superiority of RT, 5-FU, and mitomycin over 1) RT alone, 2) RT with 5-FU, and 3) neoadjuvant cisplatin/5-FU with concurrent radiation, cisplatin, and 5-FU. At present, RT with 5-FU and mitomycin is the standard of care for anal cancer patients. Recent advances include the integration of positron emission tomography into staging, radiation treatment planning and monitoring, and the use of intensity modulated RT. European randomized trials are further evaluating the role of cisplatin in the neoadjuvant, concurrent, and adjuvant settings, as well as radiation dose escalation. Other studies are evaluating the use of capecitabine, oxaliplatin, and the anti-epidermal growth factor receptor agent cetuximab with RT in this malignancy.

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Section: Anal Canal Squamous Cell Carcinoma: the Pastmentioning

confidence: 63%

Current management of anal canal cancer

Czito

Willett²

2009

Curr Oncol Rep

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“…In Nigro's paper of 21 patients treated with 30 Gy in 15 fractions combined with MMC and 5-FU followed by surgery, 57% of patients had significant downstaging or no tumour at the time of Treatment of anal cancer in the elderly N Charnley et al surgery (Buroker et al, 1977). A subsequent report of 45 patients treated with the same regimen led to 84% having complete response and 89% remaining disease-free at a median follow-up of 50 months (Leichman et al, 1985).…”

Section: Discussionmentioning

confidence: 99%

Effective treatment of anal cancer in the elderly with low-dose chemoradiotherapy

et al. 2005

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Chemoradiotherapy (CRT) is accepted as the standard initial treatment for squamous cell anal cancer. However, frail elderly patients cannot always tolerate full-dose CRT. This paper reports the results of a modified regimen for this group of patients. In all, 16 patients with biopsy-proven squamous cell carcinoma of the anal canal or margin and performance status or co-morbidity precluding the use of full-dose CRT were included in this protocol. The median age was 81 (range 77 -91). Patients received a dose of 30 Gy to the gross tumour volume plus 3 cm margin in all directions. Concurrent chemotherapy comprised 5-fluorouracil 600 mg m À2 given over 24 h on days 1 -4 of radiotherapy. The treatment was well tolerated. All 16 patients completed treatment as planned. Only one patient experienced any grade 3 toxicity (skin). The local control at a median follow-up of 16 months was 73% (13 out of 16). The overall survival was 69% and disease-specific survival 86%. This is a well-tolerated regimen for elderly/poor performance patients with anal cancer, which can achieve high rates of local control and survival. Longer follow-up will determine whether these encouraging results are maintained.

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“…The combination 5-FU and mitomycin with radiotherapy was used successfully for the treatment of squamous cell cancer of the anus 1,3,6 and later applied to carcinoma of the esophagus. Steiger et al administered 5-FU and mitomycin concurrently with 30 Gy prior to esophagectomy and found a median survival of 18 months and a complete pathologic response of 25%.…”

Section: Discussionmentioning

confidence: 99%

“…Favorable results of radiotherapy and infusional 5-fluorouracil (5-FU) combined with mitomycin in the treatment of squamous anorectal cancers [1][2][3] led to application of similar combined modality treatment for esophageal cancers. Radiotherapy doses of 30 gray (Gy) administered with two cycles of 5-FU and mitomycin produced local control and long term survival comparable with many surgical series.…”

Section: Conclusion High Dose Radiation Therapy With Concurrent 5-fmentioning

confidence: 99%