Impact of clinical and therapeutic factors on major late complications after radiotherapy with or without concomitant chemotherapy for anal carcinoma

Allal, Abdelkarim Said; Mermillod, Bernadette; Roth, Arnaud; Marti, M.-C.; Kurtz, John M.

doi:10.1016/s0360-3016(97)00390-8

Cited by 65 publications

(34 citation statements)

References 22 publications

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“…The most important prognostic factors have been defined by several studies: a tumor originating from the anal canal is more aggressive than one originating from peri-anal skin; the size of the tumor is also important, with higher T stage correlating with worse prognosis [2,[19][20][21]; differentiation and histologic type also play roles-epidermoid carcinoma has a better prognosis than adenocarcinoma; finally, prognosis is better in females than in males [2,4].…”

Section: Prognostic Factors Tumor Location and Sizementioning

confidence: 99%

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Carcinoma of the Anus: Strategies in Management

2002

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The management of anal cancer underwent an interesting transformation over the last two decades. Prior to this period, the standard definitive treatment for carcinoma of the anal canal was abdominal-perineal resection, which necessitated a permanent colostomy. The organ preservation concept appeared following the discovery of a high complete response rate from preoperative combined chemoradiation prior to abdominal-perineal resection.The organ preservation method of treatment rapidly gained popularity and ultimately saved a large number of patients from undergoing abdominal-perineal resection and colostomy. Chemoradiation treatment itself subsequently went through an evolutionary process. Several studies have sought to define the optimal chemotherapeutic regimen as well as radiation treatment dose and fractionation. Ongoing studies attempt to define an optimal treatment regimen that yields a higher cure rate while minimizing toxicity. We review the etiology, epidemiology, and treatment regimens for anal cancer.

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Section: Prognostic Factors Tumor Location and Sizementioning

confidence: 99%

“…According to some investigators, younger aged patients have worse prognoses. Treatment delay may also have an adverse effect [21].…”

Section: Lymph Node Involvementmentioning

confidence: 99%

Carcinoma of the Anus: Strategies in Management

2002

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“…Thus, alternative radiation treatment schedules tailored to reduce toxicities without compromise of disease control have been investigated, including the delivery of lower dose radiotherapy [12], continuous vs. split course treatments [13], brachytherapy [14], and the introduction of Intensity-modulated radiation therapy (IMRT) as an alternative to the conventional conformal radiation therapy (CRT) [15,16]. The current clinical practice guidelines for anal cancer recommend radiation doses of at least 45-50 Gray (Gy) with boost doses between 15 and 20 Gy , thus the study and management of late toxicities is clearly pertinent [11].…”

Section: Introduction Backgroundmentioning

confidence: 99%

Systematic review of the quality of life issues associated with anal cancer and its treatment with radiochemotherapy

Sodergren

Vassiliou

Dennis

et al. 2015

Support Care Cancer

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PurposeRadiochemotherapy is the standard of care for the treatment of anal carcinoma achieving good loco-regional control and sphincter preservation. This approach is however associated with acute and late toxicities including haematological, skin, bowel function and genito-urinary complications. This paper systematically reviews studies addressing the quality of life (QoL) implications of anal cancer and radiochemotherapy. The paper also evaluates how QoL is assessed in anal cancer. MethodsMedline, EMBASE, CINAHL, PsycInfo, Web of Science and the Cochrane Library were searched for publications (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) reporting the effects on patients of anal cancer and radiochemotherapy. ResultsOf the 152 papers reporting treatment-related effects on patients, only 11 provided a formal assessment of QoL. In the absence of an anal cancer specific measure, QoL was assessed using generic cancer instruments such as the core EORTC quality of life questionnaire (EORTC QLQ-C30) or colorectal cancer tools such as the EORTC QLQ-CR29. Bowel function, particularly diarrhoea, and sexual problems were the most commonly reported QoL concerns. The review of QoL issues of anal cancer patients treated with radiochemotherapy is limited by the QoL assessment measures used. It is argued that certain treatment-related toxicities, for example skin-induced radiation problems are overlooked or inadequately represented in existing measures. ConclusionsThis review emphasises the need to develop an anal cancer specific QoL measure and to incorporate QoL as an outcome of future trials in anal cancer. The results of this review are informative to clinicians and patients in terms of treatment decision making.

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“…Dermatologic and gastrointestinal late toxicities were also reported in 122 (42%) of 292 patients receiving chemoradiation in the UKCCCR trial 6. Allal et al reported that morbidity correlated significantly with anatomic location of tumor and prescribed external-beam dose 20. In addition, Hung et al reported only a 2% (3 patients) chronic toxicity in patients treated with cisplatin-based chemoradiation 21.…”

Section: Discussionmentioning

confidence: 99%

Anal canal carcinoma treatment results: the experience of a single institution

El-Haddad

Ahmed

Al-Suhaibany

et al. 2011

Annals of Saudi Medicine

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BACKGROUND AND OBJECTIVES:Prior to the mid-1980s, the treatment of choice for anal cancer was abdominoperineal resection. Currently, combined chemoradiation is the standard of care. Or objective was to analyze results of treatment for anal canal carcinoma treated with combined chemoradiation.DESIGN AND SETTING:0Retrospective review of data in local cancer registry at King Faisal Specialist Hospital and Research Centre (KFSHRC) from a 12-year period (1993 to 2005).METHODS:We identified patients with confirmed diagnosis of anal canal squamous cell carcinoma.RESULTS:Of 40 patients identified, 33 were considered eligible for our analysis. All patients were treated by concurrent chemoradiation with mandatory treatment break (MTB) There were 10 (30%) local recurrences. Five-year progression-free survival (PFS) was 50.9%; overall survival (OS) at 5 years was 73.4%. Patients with stage II disease had a median PFS period of 10 years, with no relapses until their last follow-up. There was no statistically significant difference in PFS between patients with stage IIIA disease and those with stage IIIB disease—44.7% and 45%, respectively (P=.8). Five-year PFS according to ‘T’ stages was as follows: T1, 66%; T2, 71%; T3, 59%; T4, 30% (P>.05). The 5-year colostomy-free survival (CFS) for all patients was 74%. Distant metastases were observed in 4 patients.CONCLUSION:Combined chemoradiation in treatment of anal cancer is effective in terms of local control and sphincter preservation. Five-year estimates of PFS, OS, as well as CFS, in patients treated with a MTB were surprisingly comparable to those determined in most non-MTB series. However, we reported a higher local failure rate, for which we are reevaluating our treatment protocol.

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Impact of clinical and therapeutic factors on major late complications after radiotherapy with or without concomitant chemotherapy for anal carcinoma

Cited by 65 publications

References 22 publications

Carcinoma of the Anus: Strategies in Management

Carcinoma of the Anus: Strategies in Management

Systematic review of the quality of life issues associated with anal cancer and its treatment with radiochemotherapy

Anal canal carcinoma treatment results: the experience of a single institution

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