Salvage abdominoperineal resection for anal cancer following chemoradiation: A proposed scoring system for predicting postoperative survival

Correa, José Humberto Simões; Castro, Leonaldson; Kesley, Rubens; Dias, Juliana; Jesus, José Paulo de; Olivatto, Luiz O.; Martins, Ivanir; Lopasso, Fabio Pinatel

doi:10.1002/jso.23283

Cited by 40 publications

(51 citation statements)

References 40 publications

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“…We found, as should be expected, that patients with positive lymph nodes and/or positive resection margins had worse overall survival. Our findings confirm those of previous studies that have linked positive margins and node status to survival outcomes . It is clear that positive lymph nodes and positive resection margins lead to worse survival as both of these factors contribute to increased local recurrence after salvage APR.…”

Section: Discussionsupporting

confidence: 90%

“…Hence, it is important to determine the factors influencing prognosis following salvage surgery. Size, margin positivity, and lymphovascular invasion have been associated with survival in previous reports . Several investigations with small patient populations have tried to determine if the indication for APR (persistent vs recurrent disease) is a predictor of survival.…”

Section: Introductionmentioning

confidence: 99%

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Early versus late salvage abdominoperineal resection for anal squamous cell carcinoma: Is there a difference in survival?

Fields

Melnitchouk

Senturk

et al. 2019

Journal of Surgical Oncology

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Background/Objectives The first‐line treatment for anal squamous cell carcinoma is Nigro protocol chemoradiotherapy. Some patients will fail curative intent chemoradiotherapy and have persistent disease while others may have an initial response followed by disease recurrence. The goal of this study is to investigate survival in anal squamous cell carcinoma patients who fail first‐line treatment. Methods The National Cancer Database (2004‐2013) was used to identify patients with anal squamous cell carcinoma. The primary outcome was overall survival. Results There were 256 patients in the early salvage group who underwent abdominoperineal resection (APR) within 6 months of completing chemoradiotherapy and 181 patients in the late salvage group who had APR 6 months or more after completion of chemoradiotherapy. Both groups of patients had similar tumor size (45 vs 50 mm; P = 0.07) and rate of positive margins (21.5% vs 15.6%;P = 0.13). There was no significant difference in overall survival between early and late salvage APR (hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.50‐1.32; P = 0.40). Conclusions The overall survival of anal squamous cell carcinoma patients undergoing early vs late salvage APR after failure of chemoradiotherapy is similar. As a result, patients with persistent disease should be offered surgery just as readily as those with recurrent disease.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Early versus late salvage abdominoperineal resection for anal squamous cell carcinoma: Is there a difference in survival?

Fields

Melnitchouk

Senturk

et al. 2019

Journal of Surgical Oncology

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“…The postoperative mortality rate in this study was comparable to previously reported rates, which ranged from 0 to 3% [3,11,16] ; however, our postoperative morbidity rate was at the lower end of the range of previous series, where complication rates from 23.7 to 100% were reported [3,11,[16][17][18] . However, in the absence of efficient curative chemotherapy or treatment, salvage surgery can be a reasonable course of curative action [19] .…”

Section: Discussionsupporting

confidence: 86%

Surgery Is an Effective Option after Failure of Chemoradiation in Cancers of the Anal Canal and Anal Margin

Delhorme

Séverac²,

Waissi³

et al. 2017

Oncology

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Background: Surgery for anal canal cancer (ACC) and anal margin cancer (AMC) is the only curative option after failure of chemoradiotherapy (CRT). This study aimed to determine the efficacy of surgery for ACC or AMC after failed CRT. Methods: This was a single-centre, retrospective study of 161 patients initially treated with CRT. We compared the survival rates of patients successfully treated by CRT with those of patients whose CRT failed (both surgically salvaged and treated palliatively). Results: Thirty-one patients underwent surgery with curative intent, 20 received palliative treatment after failure of CRT, and 110 had effective CRT. The 5-year overall survival (OS) rate was significantly higher among patients with successful CRT than among patients who underwent surgery with curative intent (86 vs. 66%, p < 0.001). On the other hand, the 5-year OS of patients treated with curative surgery was significantly better than that of patients who underwent palliative treatment (66 vs. 13.5%, p < 0.001). The postoperative morbidity and mortality rates were 32 and 3%, respectively. Considering patients with failed CRT, curative surgery was the only factor prognostic of favourable OS in the multivariate analysis. Conclusion: Curative surgery after failure of CRT for ACC or AMC remains an effective treatment to improve survival in two-thirds of cases, resulting in high but manageable morbidity.

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“…Epidemiology research showed the mortality of the inhabitant in high radiation background involved a downward direction. Epidemiology research in 48 states in America showed there was negative correlation between the level of natural radiation and the standard mortality of carcinoma (Correa et al, 2013). The result of research in high radiation background in Indian was the same with that of America (Van Bocxlaer et al, 2009).…”

Section: Discussionmentioning

confidence: 90%

Low-dose Radiation Induces Antitumor Effects and Erythrocyte System Hormesis

Yu¹,

Liu²,

Yu³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Objective: Low dose radiation may stimulate the growth and development of animals, increase life span, enhance fertility, and downgrade the incidence of tumor occurrence.The aim of this study was to investigate the antitumor effect and hormesis in an erythrocyte system induced by low-dose radiation. Methods: Kunming strain male mice were subcutaneously implanted with S180 sarcoma cells in the right inguen as an experimental in situ animal model. Six hours before implantation, the mice were given 75mGy whole body X-ray radiation. Tumor growth was observed 5 days later, and the tumor volume was calculated every other day. Fifteen days later, all mice were killed to measure the tumor weight, and to observe necrotic areas and tumor-infiltration-lymphoreticular cells (TILs). At the same time, erythrocyte immune function and the level of 2,3-diphosphoglyceric acid (2,3-DPG) were determined. Immunohistochemical staining was used to detect the expression of EPO and VEGFR of tumor tissues. Results: The mice pre-exposed to low dose radiation had a lower tumor formation rate than those without low dose radiation (P < 0.05). The tumor growth slowed down significantly in mice pre-exposed to low dose radiation; the average tumor weight in mice pre-exposed to low dose radiation was lighter too (P < 0.05). The tumor necrosis areas were larger and TILs were more in the radiation group than those of the group without radiation. The erythrocyte immune function, the level of 2,3-DPG in the low dose radiation group were higher than those of the group without radiation (P < 0.05). After irradiation the expression of EPO of tumor tissues in LDR group decreased with time. LDR-24h, LDR-48h and LDR-72h groups were all statistically significantly different from sham-irradiation group. The expression of VEGFR also decreased, and LDR-24h group was the lowest (P < 0.05). Conclusion: Low dose radiation could markedly increase the anti-tumor ability of the organism and improve the erythrocyte immune function and the ability of carrying O 2 . Low-dose total body irradiation, within a certain period of time, can decrease the expression of hypoxia factor EPO and VEGFR, which may improve the situation of tumor hypoxia and radiosensitivity of tumor itself.

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Salvage abdominoperineal resection for anal cancer following chemoradiation: A proposed scoring system for predicting postoperative survival

Abstract: Positive surgical margin, the presence of perineural and/or lymphovascular invasion and positive nodal involvement were identified as significant independent predictors of mortality. The PRS was shown to be highly predictive of postoperative outcome.

Cited by 40 publications

References 40 publications

Early versus late salvage abdominoperineal resection for anal squamous cell carcinoma: Is there a difference in survival?

Early versus late salvage abdominoperineal resection for anal squamous cell carcinoma: Is there a difference in survival?

Surgery Is an Effective Option after Failure of Chemoradiation in Cancers of the Anal Canal and Anal Margin

Low-dose Radiation Induces Antitumor Effects and Erythrocyte System Hormesis

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