Radiochemotherapy and brachytherapy could be the standard treatment for anal canal cancer in elderly patients? A retrospective single-centre analysis

Abstract

Goal To retrospectively analyse all our elderly patients (>70 years old) treated with radiotherapy ± chemotherapy (RT ± CT) followed by brachytherapy (BRT) for anal canal cancer. Background Studies on clinical outcomes and toxicities of the standard treatments for anal canal cancers in elderly patients are rare and data are not homogeneous, so a standard of care cannot be defined for these patients. Study A retrospective analysis of efficacy and safety of RT ± CT followed by BRT has been performed. The impact of the modified Charlson Index and of other different clinical and therapeutic variables on these outcomes has been also studied. Results Seventy-six elderly patients with a histological diagnosis of anal canal cancer and with a median age of 76 years (range 70-88) were treated with a curative goal. Patients received radiotherapy alone (37/76, "RT group") or radiochemotherapy (39/76, "RT-CT group"). All patients underwent a BRT boost. Five-year local control, overall survival, disease-specific survival, nodal progression-free survival and metastasis-free survival rates were 75.8, 75.8, 82.8. 87.8 and 89.0 %, respectively. Globally, the incidence of acute and late Grade 3-4 toxicities was 14.5 and 6.6 %, respectively. Only 2 patients received surgery because of severe ano-rectal toxicities. Any relationship between the modified Charlson Index and all the considered clinical outcomes was found. Conclusions Curative RT ± CT + BRT showed an acceptable toxicity profile and a good efficacy also in elderly anal canal cancer patients and should be considered as an important therapeutic option also for these patients.

Modern intensity-modulated radiotherapy with image guidance allows low toxicity rates and good local control in chemoradiotherapy for anal cancer patients

“…Moreover, imageguided radiation therapy (IGRT) is being largely adopted in the daily clinical practice, as it allows the online and offline daily verification and correction of the setup of the patients and a reduction of treatment volumes, with a consequent reduction of toxicity rates (Conde-Moreno et al 2012;Hajj and Goodman 2015). IMRT and IGRT have been recently adopted also in the treatment of anal canal cancer patients, and results are promising in terms of local control and toxicity (De Bari et al 2016;Han et al 2014;Lestrade et al 2017;Kachnic et al 2013;Vieillot et al 2012;Call et al 2016), with a particular interest in some particular classes of patients, presenting an intrinsic increased risk of higher toxicity (Lestrade et al 2013;Hauerstock et al 2010;White et al 2017). Unfortunately, the sample size of studies reporting the results of IMRT in anal cancer treatment was often limited, with also short follow-up time (often < 24 months).…”

Long-term Oncologic Outcome and Its Relevant Factors in Anal Cancer in Korea: A Nationwide Data Analysis

“…This observation may be attributed to less vigorous treatment in the advancedaged group. Recent studies, however, suggested that standard treatment could be well-tolerated and result in satisfactory oncological outcomes in elderly patients [30]. In Korea, where the proportion of the elderly population is growing, the treatment strategy for elderly patients with anal cancer needs to be assessed more carefully.…”

Nodal stage migration and prognosis in anal cancer: a systematic review, meta-regression, and simulation study

“…Excluded studies and reasons for exclusion are detailed in webappendix p16-24. Forty-five studies contributed to analyses of 5-year OS; 11 studies to ; and institution-level treatment series [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] . Median follow-up periods ranged from 1.3 to 8.6 years.…”