Multimodal therapy is feasible in elderly anal cancer patients

Dale, Jon Espen; Sebjørnsen, Sigrun; Leh, Sabine; Røsler, Cornelia; Aaserud, Stein; Møller, Bjørn; Fluge, Øystein; Erichsen, Christian; Nadipour, Saied; Kørner, Hartwig; Pfeffer, F.; Dahl, Olav

doi:10.1080/0284186x.2016.1244356

Cited by 10 publications

(8 citation statements)

References 35 publications

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“…We are unable to determine if this was related to toxic effects of treatment or if clinicians planned to deliver lower doses and omit chemotherapy for these patients; because elderly and more comorbid patients did not have higher rates of treatment interruption, we hypothesize the latter is the more likely reason. Although there are conflicting reports as to how older adults tolerate chemoradiation treatment for SCCA, [19][20][21][22][23] and some studies have suggested omission of chemotherapy or reduction in radiation dose/volume might be appropriate, 24,25 guidelines still recommended that older adults be treated similarly to their younger counterparts. 3,4 Therefore, the results of this study highlight the need for audits and quality improvement efforts to ensure that older adults are receiving guidelineconcordant treatment.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Chemoradiation Therapy Interruption and Noncompletion Among Patients With Squamous Cell Anal Carcinoma

Raphael

Booth

et al. 2020

JAMA Oncol

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IMPORTANCE Definitive chemoradiation for anal cancer is effective but may be associated with toxic effects, and some patients may not be able to complete the planned treatment. Identifying factors associated with treatment interruption and noncompletion is important to target quality improvement efforts. OBJECTIVE To identify rates of chemoradiation treatment interruption or noncompletion and factors associated with this among patients with anal cancer treated in routine clinical practice. DESIGN, SETTING, AND PARTICIPANTSIn this population-based, retrospective cohort study, the Ontario Cancer Registry was used to identify all incident cases of squamous cell anal cancer treated with curative-intent radiation from 2007 to 2015 in Ontario, Canada. Final analysis of data was performed on August 9, 2019.EXPOSURES Curative-intent radiation therapy. MAIN OUTCOMES AND MEASURESTreatment interruption was defined as more than 7 days between fractions of radiation. Radiation completion was defined as receipt of 45 Gy or more and 25 fractions of radiation. Chemoradiation completion was defined as radiation completion and 2 doses of combination chemotherapy. Associations between patient factors and treatment interruption and noncompletion were estimated with log-binomial models. Cox proportional hazard models were used to estimate the association of treatment interruption or noncompletion with all-cause death, cancer-specific death, and the combined outcome of colostomy or death. RESULTSOverall, 1125 patients with stage I-III anal cancer were treated with curative-intent radiation. Treatment interruptions occurred in 262 (23%). Radiation and chemoradiation noncompletion occurred in 199 (18%) and 280 (25%), respectively. No associations were found to correlate with an increased risk of treatment interruption. Patients older than 70 years were less likely to complete chemoradiation (risk ratio [RR], 0.60; 95% CI, 0.52-0.70), compared with those younger than 50 years. Patients with a higher number of comorbidities were also less likely to complete chemoradiation (RR, 0.70; 95% CI, 0.51-0.95). Patients who did not complete chemoradiation had a higher risk of requiring salvage abdominoperineal resection (

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Section: Discussionmentioning

confidence: 99%

Factors Associated With Chemoradiation Therapy Interruption and Noncompletion Among Patients With Squamous Cell Anal Carcinoma

Raphael

Booth

et al. 2020

JAMA Oncol

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“…Older patients had a 5 year OS of 60.8% compared to 74.6% in younger patients, however this was not statistically signi cant, nor was there a signi cant difference in LRC. Although a lack of signi cant difference in OS is unexpected (21), this outcome is most probably due to a to small sample size.…”

Section: Discussionmentioning

confidence: 94%

Treatment results for patients with squamous-cell carcinoma of the anus, a single institution retrospective analysis

Neelis

Kip

Speetjens

et al. 2022

Preprint

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Background and purpose To gain insight into the treatment outcomes for anal cancer at a retrospective analysis was performed with a special emphasis on trends in outcome and toxicities over time and on treatment of elderly patients. Materials and methods Medical records of 98 consecutive patients with squamous cell carcinoma of the anus of all stages treated with curative intent between 01-01-2009 and 31-12-2018 were analyzed with follow up until 31-12-2020. Standard tumor and pathological lymph node dose were 59.4Gy or 60Gy, elective nodal regions were treated with 45Gy. Radiotherapy techniques in this period evolved from 3D conformal to IMRT and VMAT. In 23 patients electron beams were used. Results Median age was 63 years (range 41 – 88), majority female patients (60%). Twenty three patients were > 75 years old. The TNM stages were I, II, IIIA, and IIIB in 18%, 40%, 15% and 27%, fifty-eight % of patients had N0 status. Concurrent mitomycin C and 5-fluoruracil-based chemotherapy was given in 63 patients (64%). Five-year overall survival (OS), disease free survival (DFS), locoregional control (LRC) and colostomy free survival (CFS) were 71%, 80%, 82%, and 82% for the whole group. Results in patients > 75 years of age were not statistically different from those in younger patients. With the introduction of more conformal techniques DFS did not change and toxicities decreased. Conclusion Real word treatment outcomes per disease stage were in line with what is reported in literature. Older patients should also be offered treatment with curative intent.

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“…Older patients had a 5 year OS of 60.8% compared to 74.6% in younger patients, however this was not statistically significant, nor was there a significant difference in LRC. Although a lack of significant difference in OS is unexpected [ 22 ], this outcome is most probably due to a to small sample size.…”

Section: Discussionmentioning

confidence: 99%

Treatment results for patients with squamous-cell carcinoma of the anus, a single institution retrospective analysis

et al. 2022

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Background and purpose To gain insight into the treatment outcomes for anal cancer a retrospective analysis was performed with a special emphasis on trends in outcome and toxicities over time and on treatment of elderly patients. Materials and methods Medical records of 98 consecutive patients with squamous cell carcinoma of the anus of all stages treated with curative intent between 01-01-2009 and 31-12-2018 were analyzed with follow up until 31-12-2020. Standard tumor and pathological lymph node dose were 59.4 Gy (median 59.4 Gy, range 59.4–70 Gy) or 60 Gy (no deviation from intended dose), elective nodal regions were treated with 45 Gy (no deviations). Radiotherapy techniques in this period evolved from 3D-conformal to IMRT and VMAT. In 23 patients electron beams were used. Results Median age was 63 years (range 41–88), the majority of patients were female (60%). Twenty three patients were > 75 years old. The TNM stages were I, II, IIIA, and IIIB in 18%, 40%, 15% and 27%, 58% of patients had N0 status. Concurrent mitomycin C and 5-fluoruracil-based chemotherapy was given in 63 patients (64%). Five-year overall survival (OS), disease free survival (DFS), locoregional control (LRC) and colostomy free survival (CFS) were 71%, 80%, 82%, and 82% for the whole group. Results in patients > 75 years of age were not statistically different from those in younger patients. With the introduction of more conformal techniques DFS did not change and toxicities decreased. Conclusion Real word treatment outcomes per disease stage were in line with what is reported in literature. Older patients should also be offered treatment with curative intent.

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Multimodal therapy is feasible in elderly anal cancer patients

Cited by 10 publications

References 35 publications

Factors Associated With Chemoradiation Therapy Interruption and Noncompletion Among Patients With Squamous Cell Anal Carcinoma

Factors Associated With Chemoradiation Therapy Interruption and Noncompletion Among Patients With Squamous Cell Anal Carcinoma

Treatment results for patients with squamous-cell carcinoma of the anus, a single institution retrospective analysis

Treatment results for patients with squamous-cell carcinoma of the anus, a single institution retrospective analysis

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