TY - JOUR
T1 - Squamous-cell carcinoma of the anal canal
T2 - Predictors of treatment outcome
AU - Roohipour, Ramin
AU - Patil, Sujata
AU - Goodman, Karyn A.
AU - Minsky, Bruce D.
AU - Wong, W. Douglas
AU - Guillem, José G.
AU - Paty, Philip B.
AU - Weiser, Martin R.
AU - Neuman, Heather B.
AU - Shia, Jinru
AU - Schrag, Deborah
AU - Temple, Larissa K.F.
N1 - Funding Information:
Dr. Temple is funded by the Society of University Surgeons and by the American Society of Clinical Oncology. Read at the meeting of The American Society of Colon and Rectal Surgeons, June 2 to 6, 2007. No reprints available. Address of correspondence: Larissa K. F. Temple, M.D., Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-1079, New York, New York 10021. E-mail:[email protected]
PY - 2008/2
Y1 - 2008/2
N2 - PURPOSE: The incidence of anal canal squamous-cell carcinoma is increasing. Limited data exist on predictors of treatment failure. This study was designed to identify predictors for relapse/persistence after first-line therapy. METHODS: Using one database, we identified 131 Stages I-III patients treated for primary anal canal squamous-cell carcinoma at our institution from December 1986 to August 2006, with minimum six-month follow-up. Demographic, pathologic, treatment, and outcome data were extracted. Treatment failure was defined as biopsy-proven persistence or relapse (local and/or distant). Univariate, bivariate, and multivariate survival analyses were performed. RESULTS: Of 131 patients (median age, 58.3 years; median follow-up, 2.9 (range, 0.6-11.2) years), 66 percent were females, 43.5 percent were Stage II, and 11 (8 percent) were HIV-positive. Surgery only (local excision) was uncommon (6.9 percent, n=9). One hundred twenty-two patients (93.1 percent) received radiotherapy; two required preradiotherapy diversion. Although 114 (93.4 percent) completed radiotherapy, most required treatment breaks, making total duration of radiotherapy longer than planned. Almost all patients undergoing radiotherapy (96.7 percent, 118/122) also had chemotherapy: 118 (100 percent, Stages I-III) had concurrent chemotherapy: (98 (83.8 percent) mitomycin/5-fluorouracil, 12 (10.2 percent) cisplatin/5-fluorouracil, 8 (6.8 percent) 5-fluorouracil alone); 35 of 46 (76 percent) Stage III patients received induction chemotherapy (34 (97.1 percent) cisplatin/5-fluorouracil, 1 (2.8 percent) 5-fluorouracil alone). Many (44 percent Stages I/II, 48.9 percent Stage III) required dose adjustments. Thirty-seven patients (28.2 percent) failed first-line therapy. There were no differences between patients with relapse (n=22) or persistence (n=15) of disease. Bivariate analyses demonstrated that T stage (P=0.0019), completion of radiotherapy, and total radiotherapy dose (P=0.03) were all significantly associated with treatment failure. On multivariate analyses, disease stage (P=0.05) and completion of radiotherapy (P=0.01) remained significant predictors of relapse-free survival. CONCLUSIONS: Tolerance of chemoradiation seems to be an important predictor of treatment success. Effective therapies with less acute toxicity must be identified.
AB - PURPOSE: The incidence of anal canal squamous-cell carcinoma is increasing. Limited data exist on predictors of treatment failure. This study was designed to identify predictors for relapse/persistence after first-line therapy. METHODS: Using one database, we identified 131 Stages I-III patients treated for primary anal canal squamous-cell carcinoma at our institution from December 1986 to August 2006, with minimum six-month follow-up. Demographic, pathologic, treatment, and outcome data were extracted. Treatment failure was defined as biopsy-proven persistence or relapse (local and/or distant). Univariate, bivariate, and multivariate survival analyses were performed. RESULTS: Of 131 patients (median age, 58.3 years; median follow-up, 2.9 (range, 0.6-11.2) years), 66 percent were females, 43.5 percent were Stage II, and 11 (8 percent) were HIV-positive. Surgery only (local excision) was uncommon (6.9 percent, n=9). One hundred twenty-two patients (93.1 percent) received radiotherapy; two required preradiotherapy diversion. Although 114 (93.4 percent) completed radiotherapy, most required treatment breaks, making total duration of radiotherapy longer than planned. Almost all patients undergoing radiotherapy (96.7 percent, 118/122) also had chemotherapy: 118 (100 percent, Stages I-III) had concurrent chemotherapy: (98 (83.8 percent) mitomycin/5-fluorouracil, 12 (10.2 percent) cisplatin/5-fluorouracil, 8 (6.8 percent) 5-fluorouracil alone); 35 of 46 (76 percent) Stage III patients received induction chemotherapy (34 (97.1 percent) cisplatin/5-fluorouracil, 1 (2.8 percent) 5-fluorouracil alone). Many (44 percent Stages I/II, 48.9 percent Stage III) required dose adjustments. Thirty-seven patients (28.2 percent) failed first-line therapy. There were no differences between patients with relapse (n=22) or persistence (n=15) of disease. Bivariate analyses demonstrated that T stage (P=0.0019), completion of radiotherapy, and total radiotherapy dose (P=0.03) were all significantly associated with treatment failure. On multivariate analyses, disease stage (P=0.05) and completion of radiotherapy (P=0.01) remained significant predictors of relapse-free survival. CONCLUSIONS: Tolerance of chemoradiation seems to be an important predictor of treatment success. Effective therapies with less acute toxicity must be identified.
KW - Anal canal
KW - Squamous-cell carcinoma
KW - Treatment outcomes
UR - https://www.scopus.com/pages/publications/39149086376
U2 - 10.1007/s10350-007-9125-z
DO - 10.1007/s10350-007-9125-z
M3 - Article
C2 - 18180997
AN - SCOPUS:39149086376
SN - 0012-3706
VL - 51
SP - 147
EP - 153
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
IS - 2
ER -