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Real-world outcomes of anal cancer patients treated with radical chemoradiation
Background
Anal squamous cell carcinoma (SCC) is an uncommon malignancy of all cancers of the lower intestinal tract. Concurrent chemoradiation (ChRT) with 5-fluorouracil (5-FU) and mitomycin-C (MMC) is the standard of care. Until 1970, the surgical approach was the standard of care; however, Nigro and his colleagues demonstrated that might be possible to cure anal carcinoma without surgery in patients treated with ChRT. In recent decades, studies have shown that capecitabine can replace 5-FU; nevertheless, the use of cisplatin instead of MMC did not show better results.
Methods
This is a retrospective, single-center study, which included patients with SCC, treated with concomitant ChRT with radical intent in the period of 10 years, from January 2012 to December 2020, in a hospital in the north of Portugal. Response to treatment was considered at 6 months after ChRT by performing pelvic MRI and/or positron emission tomography. The inclusion of stage IV patients at diagnosis, who started ChRT treatment with a radical intention, was allowed as long as the treatment of metastases was local. Data were collected through the analysis of clinical records and analyzed by SPSS software. Survival was assessed by the Kaplan-Meier method. Endpoints: to assess overall survival (OS) and progression-free survival (DFS), benefit rate, overall response rate and occurrence of grade 3 and 4 toxicities (CTCAE version).
Results
Twenty-five patients were included, with a mean age of 62 years (40-93), of which 15 (60%) were female. Regarding performance status, 15 (60%) had ECOG 0, 8 (32%) had ECOG 1, and 2 (8%) had ECOG 2. The main presenting symptoms were: rectal bleeding (44%), pain in the anal region (36%), diarrhea (8%), inguinal adenopathy (4%), tenesmus (4%), occlusive condition (4%). Regarding the initial stage, the majority were IIIa (n=13, 52%) and IIIb (n=6, 24%). Radiation therapy treatment was performed with an average dose of 59Gy (50-69.7) and with an average duration of 45 days (31-70). Chemotherapy treatment was performed in most cases (n=22, 88%) with 5-Fu and MMC. Complete response to treatment was seen in 80% of patients (n=20), partial response in 8% (n=2) of patients and stable disease in 1 patient. Only 1 patient progressed during treatment and 1 patient died at the end of ChRT. OS was 64.4±6.8 months and DFS was 62.2±7 months. Acute toxicity: G3 perineal radiodermatitis was observed in 12 cases (48%) and G4 in 1 case; G3 diarrhea occurred in 2 cases (8%) and G3 and G4 neutropenia in 4 cases (16%). Of the late complications of treatment, the most frequent was radical proctitis (n=3, 12%) followed by stenosis of the anal canal (n=2, 8%).
Conclusions
In our retrospective study treatment of SCC with radical ChRT was associated with complete remission in 80% of patients, with a clinical benefit rate greater than 90% with acceptable acute and late toxicity. OS and DLS were similar to those described in the literature.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
