Management of anal cancer patients – a pattern of care analysis in German-speaking countries

Abstract

Background: Radiotherapy dose and target volume prescriptions for anal squamous cell carcinoma (ASCC) vary considerably in daily practice and guidelines, including those from NCCN, UK, Australasian, and ESMO. We conducted a pattern-of-care survey to assess the patient management in German speaking countries. Methods: We developed an anonymous questionnaire comprising 18 questions on diagnosis and treatment of ASCC. The survey was sent to 361 DEGRO-associated institutions, including 41 university hospitals, 118 nonuniversity institutions, and 202 private practices. Results: We received a total of 101 (28%) surveys, including 20 (19.8%) from university, 36 (35.6%) from nonuniversity clinics, and 45 (44.6%) from private practices. A total of 28 (27.8%) institutions reported to treat more than 5 patients with early-stage ASCC and 42 (41.6%) institutions treat more than 5 patients with locoregionallyadvanced ASCC per year. Biopsy of suspicious inguinal nodes was advocated in only 12 (11.8%) centers. Screening for human immunodeficiency virus (HIV) is done in 28 (27.7%). Intensity modulated radiotherapy or similar techniques are used in 97%. The elective lymph node dose ranged from 30.6 Gy to 52.8 Gy, whereas 87% prescribed 50.4-55. 8 Gy (range: 30.6 to 59.4 Gy) to the involved lymph nodes. The dose to gross disease of cT1 or cT2 ASCC ranged from 50 to ≥60 Gy. For cT3 or cT4 tumors the target dose ranged from 54 Gy to more than 60 Gy, with 76 (75.2%) institutions prescribing 59.4 Gy. The preferred concurrent chemotherapy regimen was 5-FU/Mitomycin C, whereas 6 (6%) prescribed Capecitabine/Mitomycin C. HIV-positive patients are treated with full-dose CRT in 87 (86.1%) institutions. First assessment for clinical response is reported to be performed at 4-6 weeks after completion of CRT in 2 (2%) institutions, at 6-8 weeks in 20 (19.8%), and 79 (78%) institutions wait up to 5 months. Conclusions: We observed marked differences in radiotherapy doses and treatment technique in patients with ASCC, and also variable approaches for patients with HIV. These data underline the need for an consensus treatment guideline for ASCC.

A Pattern of Care Report on the Management of Patients with Squamous Cell Carcinoma of the Anus—A Study by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Tumors Study Group

“…Conversely, FDG-PET is considered an optional or second-level examination by more than 60% of respondents. This is in line with the results of a recent survey carried out in German-speaking countries [16,17]. In the recent ESMO guidelines, FDG-PET is considered as an exam to be recommended, but not mandated [8].…”

Intensity-Modulated Radiotherapy Associated With Improved Survival Outcome in Anal Cancer

“…Similar results have been reported in a survey in German-speaking countries, with 97% of the centers reporting the use of IMRT in the management of SCC-AC. In addition, almost 12% reported the use of PET-CT as a routine examination in the treatment planning procedure (14). The possible reasons for the wide adoption of the IMRT are the potential to reduce the radiation For comparison of treatment groups, the Chi-Square § and the Mann-Whitney U + Tests were applied, * p-value < 0.05.…”

Practice of radiation therapy for anal cancer in Austria—a survey on behalf of the Austrian radiation oncology society gastrointestinal tumor group (ÖGRO-GIT)

“…With a response rate of 93%, our survey represents a complete and valid image of the practice in Austria, clearly outmatching values reached in other countries. For example, a similar German survey recently reported only a 28% response rate [3]. We evaluated areas of agreement and disagreement between the centers and compared the general approach with the recommendations of major international guidelines, namely NCCN [1] and ESMO-ESSO-ESTRO (ESMO) [2] in their latest version.…”

“…In contrast, PET-CT is used for staging in only a minority (38%), although recommended (if available) by NCCN [1] and ESMO [2] for possible advantages in staging accuracy and target volume delineation [4][5][6]. Only 15% of the Austrian centers indicated routine HIV testing, which is even lower than the 27% rate reported in the recent German survey [3]. This might be due to the fact that according to Austrian regulations, HIV testing requires a special informed consent form.…”