Effectiveness of radical radiochemotherapy (RCT) in patients with anal cancer managed at the Bank of Cyprus Oncology Centre: 15 years’ experience
Authors: V. Vassiliou, M. Pittaka, A. Gudenian, K. Michailidou, L. Michael, I. Constantinou, P. Kountourakis, D. Andreopoulos, M. Talias, M. Kantaris, M. Charalambous
Journal: Annals of Oncology (2018)

Introduction: Anal cancers are rare, accounting for 2% of gastrointestinal malignancies. Their incidence is increasing, particularly in women. The current standard of care is concurrent RCT. Overall 5-year survival rates reach 75%, colostomy free survival rate is 65-70% and complete pathological response rates reach 90%. While treatment outcomes are excellent, associated toxicities are high. Clinician-reported acute grade 3/4 toxicities can be as high as 80% (1). Methods: The files of patients diagnosed with non-metastatic anal cancer managed with radical RCT were retrospectively reviewed in respect to effectiveness and toxicity. All patients underwent staging MRI prior and post RCT. CT scans were performed prior to RCT onset, 6 monthly up to 2 years and yearly up to 5 years. Patients were clinically evaluated 3 monthly for the first 2 years and 6 monthly thereafter. Toxicity was recorded by using CTCAEv4 criteria. Statistical analysis of time-to-event data was done using Kaplan-Meier plots. Results: From 2003 to 2017 sixty-nine patients (38 females, 31 males) received RCT with 2 cycles of MMC-5FU. Radiotherapy dose ranged between 5220-5940cGy. Median age was 63 years. Two patients had stage I disease, 22 stage II, 9 stage IIIA and 36 stage IIIB. IMRT technique was used in 56% of patients and conformal RT (CRT) in 44% of patients. Median follow up (FU) was 31 months. Complete clinical response rate at 3 months was 84%. Three-year overall survival (OS), Disease free survival (DFS), Locoregional disease free survival (LDFS), metastasis free survival (MFS) and colostomy free survival (CFS) rates were 85%, 82%, 87%, 89% and 82% respectively. 3 year OS was 100% for stage I, 89.5% for stage II, 83.3% for stage IIIA and 75.2% for stage IIIB patients. Rates remained unchanged after 3y FU. No significant differences in survivals were noted between patients managed with IMRT vs CRT, apart from OS that favoured those managed with IMRT (p < 0.023). Acute grade 3/4 toxicity rates were: skin dermatitis 43.5%, diarrhoea 10.1%, proctitis 39.1%, cystitis-urinary frequency 2.8%, neutropenic fever 7.2%, thrombocytopenia 2.9%, and Leukopenia 13%. Late grade 3/4 toxicity rates were minimal with 2 patients developing a fistula (2.8%) and 3 anal stenosis (3.3%). One patient developed a secondary malignancy (sarcoma) at 4 years of FU. Acute grade 3 dermatitis was more frequent in patients managed with CRT (53.3% vs 35.9%) whereas no differences were noted in acute grade 3 diarrhoea (10% each). Grade III leukopenia was more frequent in CRT patients. Conclusion: We herein report the results of a single institutional study involving patients with anal carcinoma. Survival rates are comparable to those of published literature data. An interesting characteristic of this study is the possibility to compare the results between patients managed with CRT vs IMRT. Interestingly OS was statistically significantly higher in patients treated with IMRT. Moreover, grade 3/4 acute toxicity rates were higher in CRT patients.