Is neoadjuvant chemotherapy prior to radio‐chemotherapy beneficial in T4 anal carcinoma?

Moureau-Zabotto, Laurence; Viret, F.; Giovaninni, Marc; Lelong, Bernard; Bories, Erwan; Delpero, Jean‐Robert; Pesenti, Christian; Caillol, Fabrice; Chaisemartin, Cécile de; Minsat, Mathieu; Monges, Geneviève; Sarran, A.; Resbeut, M.

doi:10.1002/jso.21866

Cited by 11 publications

(9 citation statements)

References 57 publications

(53 reference statements)

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“… 32 A retrospective study conducted by Moureau‐Zabotto L et al revealed that patients who received ICT had a statistically significant better 5‐year CFS in France. 33 In the present study, 10 patients received ICT before CCRT and might contribute to a better survival (Figure S3 ). As most patients with ASCC were diagnosed as locally advanced, we believe that more active systemic treatment was necessary.…”

Section: Discussionmentioning

confidence: 65%

“…In 2005, a Swedish study suggested that platinum‐based neoadjuvant chemotherapy could improve the CR rate (92% vs. 76%, p < 0.01) and 5‐year OS rate (63% vs. 44%, p < 0.05) for anal cancer with T ≥ 4 cm or N + compared with radiotherapy ± bleomycin 32 . A retrospective study conducted by Moureau‐Zabotto L et al revealed that patients who received ICT had a statistically significant better 5‐year CFS in France 33 . In the present study, 10 patients received ICT before CCRT and might contribute to a better survival (Figure ).…”

Section: Discussionmentioning

confidence: 99%

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Comprehensive treatment experience of anal squamous cell carcinoma from a tertiary cancer center in South China

Yuan

Xie

et al. 2021

Cancer Medicine

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Background Anal squamous cell carcinoma (ASCC) is a rare malignant tumor with increasing incidence. The goal of our study was to analyze the treatment outcome and prognostic factors of ASCC in South China in the past half‐century. Methods This study retrospectively included 59 patients with ASCC admitted from 1975 to 2018 in Sun Yat‐sen University cancer center. The clinical records and follow‐up information of all patients were collected. Survival analysis and univariate and multivariate regression analyses were performed using the “survival” and “survminer” packages of R software. Results In 59 patients, 5 patients had distant metastasis at diagnosis. Among 54 M0 stage patients, 33 patients received chemoradiotherapy (CRT), 19 patients received local surgery, and 2 patients refused curative treatment and received the best supportive treatment (BST). The most common grade 3–4 acute toxicities during treatment were myelosuppression and radiation dermatitis. The median follow‐up time was 32 months. For the whole group, the 3‐year and 5‐year overall survival (OS) rates and disease‐free survival (DFS) were 71.1% and 63.6%, and 73.4% and 69.0%, respectively. Multivariate regression analysis showed that the T3–4 stage was an independent prognostic risk factor for OS, progression‐free survival (PFS), and DFS. And M1 was an independent prognostic risk factor for PFS and DFS. Patients in stage M0 mainly treated with CRT had better local control than those mainly treated with surgery (p = 0.027). For M0 patients, induction chemotherapy combined with CRT tends to prolong OS compared with CRT alone (p = 0.26). The 3‐year colostomy‐free survival for the whole group was 81.1%. Conclusions CRT is recommended as the first choice for the treatment of M0 stage ASCC. Induction chemotherapy may bring better survival benefits for some patients. Patients with ASCC in China seem to have a better local control rate, which suggested different treatment strategies may be needed in China.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Comprehensive treatment experience of anal squamous cell carcinoma from a tertiary cancer center in South China

Yuan

Xie

et al. 2021

Cancer Medicine

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Section: Chemotherapymentioning

confidence: 99%

“…Retrospective studies and a recent meta-analysis have examined the use of chemotherapy without radiation in the neoadjuvant setting in the treatment of anal cancer, and there seems to be no clear advantage [37,38]. However, patients with T4 lesions, in special circumstances, may benefit from induction chemotherapy [37]. Patients who have been treated with prior pelvic radiation and those who are minimally symptomatic or have widespread systemic disease may be candidates for this approach.…”

Section: Chemotherapymentioning

confidence: 99%

Anal Cancer

Sands

Mahmoud

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Tumors of the anal region are divided into anal and perianal cancers with different paths of lymphatic drainage.• Squamous cell carcinoma (SCC) is the most common type of anal cancer. • Chemoradiotherapy is the mainstay for anal (SCCa). The standard chemotherapy consists of 5-FU and mitomycin. The minimum dose of radiation is 45 Gy to the primary tumor. • Inguinal node metastasis can be diagnosed with PET-CT and managed with radiation. • Surgery for anal canal cancer is limited to very small lesions and salvage situations following failed chemoradiotherapy. • Anal adenocarcinoma can arise from an anal gland or chronic fistula tract. They can be difficult to distinguish from distal rectal cancers. These tumors are staged and treated similar to rectal cancers with a lower overall survival. • Verrucous carcinomas are characterized by large size and lack of invasion. Treatment is mainly wide surgical excision. • Anal melanoma is a rare and aggressive tumor. Survival is very poor. Abdominoperineal resection may help to control local disease but does not prolong life expectancy; therefore, local excision is often a first choice when possible. • Perianal Paget's disease -or intraepithelial adenocarcinoma -is frequently associated with other malignancies.Treatment is focused on surgical excision and may require mapping biopsies to plan resection.• Basal cell carcinoma of the perianal region is treated with wide local excision. • Gastrointestinal stromal tumors can be managed with wide local excision or radical excision depending on margin status. Preoperative treatment with tyrosine kinase inhibitors may enhance resectability.

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“…The lack of benefit of induction chemotherapy before CRT was cemented by the UNICANCER ACCORD 03 trial [26]. The exception might be T4 tumours, which may benefit from neoadjuvant treatment (5FU plus cisplatin) with lower colostomy rates [27]. In the ACCORD 03 study, intensification of the radiation boost to 20-25 Gy (total dose of 65-70 Gy) vs 15 Gy (total dose of 60 Gy) was also tested and proved not to have a significant effect on tumour response, although there was a suggestion of better 3-year colostomy-free survival.…”

Section: Introduction Abstractmentioning

confidence: 99%

Treatment of Anal Carcinoma - A Review of the Literature

2020

Br J Cancer Res

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Anal carcinoma is considered a rare tumour, accounting for 1.5% of the digestive tract tumours [1]. Historically, incidence is higher in women, but it seems to be increasing in both sexes, especially in males [2]. The most common histology is squamous cell carcinoma, which will be the focus of this review. Adenocarcinoma in this location should be managed according to the principles of rectal cancer and melanoma should be treated as such.The last few decades have witnessed an important evolution in the understanding of the pathogenesis and adequate treatment of this entity.Several risk factors have been described for anal carcinoma, including HPV and HIV infection, history of sexually transmitted diseases, history of anal intercourse, previous HPV-related gynecological cancers (vulvar, cervical and vaginal cancer), immunosuppressive disorders and tobacco smoking [1][2][3][4][5][6]. The usual clinical presentation is rectal bleeding, but mass sensation and/ or pain can also be described [7].Staging should follow the 8th AJCC TNM classification and is mostly done clinically. Prognosis is determined mainly by the size of the tumour and involvement of lymphatic nodes, with tumours above 5cm in diameter carrying a worse prognosis [1][2][3][4][5][6][7][8]. Positivity for HPV and/or p16 are predictive of higher local tumour control and better overall survival (OS) [9].These tumours are very responsive to chemoradiation (CRT), which is the main treatment of localized tumours, allowing organ preservation and high rates of local control and overall survival. Only a minority (around 15%) of patients present with metastized disease at the time of diagnosis and therapeutic op-tions are limited [10,11]. MethodsA review of the existing literature on the treatment anal carcinoma was carried out using PubMed and the most important and informative articles were selected, with special attention to existing phase III clinical trials. Discussion Approach for non-metastatic anal carcinomaIn the past, treatment for anal carcinoma was primarily surgical in the form of abdominal perineal resection (APR). This technique resulted in high morbidity, frequent local recurrence and increased mortality, with reported OS at five-years between 40-70% [1-12].In the 70s, the first reports of pre-operative CRT for anal carcinoma found interesting rates of tumour regression with a combination of 5-FU and mitomycin or porfiromycin, concurrent with pre-operative doses of radiation (30 Gy delivered in 15 fractions to the pelvis, medial nodes and anal canal).11 Multiple subsequent clinical trials have proved CRT without surgery to be the best treatment for anal carcinoma [13].In 1997, the randomized clinical trial UKCCCR Anal Cancer Trial I (ACT I) established the advantage of CRT (45 Gy in 20 or 25 fractions plus a 15 Gy to 25 Gy boost) with 5-FU and mitomycin when compared to RT alone, by reducing the risk of local failure with little increase in acute side effects [14]. These findings were confirmed in a follow-up analysis conduct-

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Is neoadjuvant chemotherapy prior to radio‐chemotherapy beneficial in T4 anal carcinoma?

Abstract: T4 anal carcinoma can be treated with a curative intent using a sphincter-sparing approach of CRT, and neo-adjuvant chemotherapy should be considered prior to radiotherapy.

Cited by 11 publications

References 57 publications

Comprehensive treatment experience of anal squamous cell carcinoma from a tertiary cancer center in South China

Comprehensive treatment experience of anal squamous cell carcinoma from a tertiary cancer center in South China

Anal Cancer

Treatment of Anal Carcinoma - A Review of the Literature

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