Optimal management of squamous cell carcinoma of the anal canal: where are we now?

Eng, Cathy; Ahmed, Shahab

doi:10.1586/14737140.2014.919861

Cited by 7 publications

(1 citation statement)

References 49 publications

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“…Squamous cell carcinoma of the anus remains a relatively rare cancer, but its incidence has now increased to 2.6% of all new cancer cases of the digestive tract diagnosed in the US in 2016 [ 12 ]. Any single center is unlikely to have a large institutional experience with SCCA; therefore, a large national database review offers the most meaningful approach for analyzing data on this malignancy [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Patterns of care for anal cancer in the United States - a comparison between academic and community cancer centers

Pricolo¹,

Bonvini²,

Abelli³

2018

BMC Cancer

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BackgroundManagement of squamous cell carcinoma of the anus (SCCA) is becoming more relevant, as its incidence increases. The purpose of this study was to investigate possible differences in patient population and care delivery for SCCA between academic and community cancer programs in the United States.MethodsA review of available data from the American College of Surgeons Committee on Cancer National Cancer DataBase focused on gender, age, race, type of health insurance, comorbidity score, distance traveled for care, stage at diagnosis, and therapy utilization (surgery, chemotherapy, and radiation therapy) as first course of treatment (FCT). The analysis included 38,766 patients treated for SCCA. Of them, 14,422 patients received treatment at Academic Cancer Programs (ACPs), while 24,344 were treated at Community Cancer Programs (CCPs) between the years 2003 and 2013.ResultsOver the 11-year study period, ACPs had significantly more male patients, of younger age, a greater non-white race population, with more Medicaid or no insurance coverage, who traveled farther for cancer center care (p < 0.001). There was no difference between ACPs and CCPs with respect to Charlson co-morbidity score and stage of SCCA at diagnosis. For stage 0 patients, use of chemotherapy was 8% for ACPs, 9% for CCPs, and use of radiotherapy was 10% for ACPs and 14% for CCPs. The incidence of stage unknown was identical at both ACPs and CCPs (11.5%). CCPs had a greater overall utilization of radiation therapy as FCT for stage 0, I, II and IV patients (p < 0.001).ConclusionsOur study indicates that gender, demographic and socio-economic differences exist in the patient population with SCCA accessing different cancer programs in the US. The high incidence of stage unknown patients reflects ongoing challenges in the pre-treatment phase. A significant percentage of stage 0 patients received systemic chemotherapy and/or radiotherapy, rather than surgery alone. Despite comparable stage at diagnosis and comorbidity scores between ACPs and CCPs, there appear to be variations in treatment choices, especially with the use of radiotherapy, with associated cost and toxicity risks. Further analysis and monitoring of SCCA management in the US may lead to improved compliance with NCCN guidelines.

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Section: Discussionmentioning

confidence: 99%

Patterns of care for anal cancer in the United States - a comparison between academic and community cancer centers

Pricolo¹,

Bonvini²,

Abelli³

2018

BMC Cancer

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Anal Cancer

Eng

Shridhar

Chan

et al. 2018

The American Cancer Society's Oncology in Practice

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Advances in the Management of Anal Cancer

Julie

Goodman

2016

Curr Oncol Rep

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Although anal squamous cell carcinoma (ASCC) is an uncommon malignancy, its incidence has been increasing markedly in recent decades due to its association with human papilloma virus (HPV) infection. The well-established standard of care for localized ASCC consists of the combination of 5-fluorouracil (5FU) and mitomycin (MMC) chemotherapy, concurrent with external beam radiation therapy (EBRT). However, newer techniques are being actively pursued, including the use of newer radiation therapy (RT) technologies, such as intensity-modulated radiation therapy (IMRT). The areas of debate and development include the dosing and timing of MMC delivery, the role of cisplatin chemotherapy as an alternative to MMC, the replacement of the standard 96-h infusion of 5FU with oral capecitabine, the use of targeted chemotherapy agents, and the duration and dose of RT.

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Optimal management of squamous cell carcinoma of the anal canal: where are we now?

Cited by 7 publications

References 49 publications

Patterns of care for anal cancer in the United States - a comparison between academic and community cancer centers

Patterns of care for anal cancer in the United States - a comparison between academic and community cancer centers

Anal Cancer

Advances in the Management of Anal Cancer

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