Chemoradiotherapy with Brachytherapy or Electron Therapy Boost for Locally Advanced Squamous Cell Carcinoma of the Anus—Reducing the Colostomy Rate

• Published in: Journal of gastrointestinal cancer Vol. 48; no. 1; pp. 1 - 7
• Main Authors: Kent, C., Bessell, E. M., Scholefield, J. H., Chappell, S., Marsh, L., Mills, J., Sayers, I.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-03-2017
• Subjects: Anus Neoplasms - drug therapy; Anus Neoplasms - pathology; Anus Neoplasms - radiotherapy; Brachytherapy - methods; Cancer Research; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Chemoradiotherapy; Colostomy; Electrons; Female; Gastroenterology; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Research; Radiotherapy; Survival Analysis; Tomography, X-Ray Computed; Brachytherapy; Radiotherapy; Stoma formation; Boost; Anal cancer; Electron beam therapy
• ISSN: 1941-6628; 1941-6636
• DOI: 10.1007/s12029-016-9850-4

Purpose
The aim of this study is to determine overall survival, disease-specific survival and stoma-free survival after treatment of squamous cell carcinoma of the anus with chemoradiotherapy followed by brachytherapy or electron boost in a recent cohort of patients.
Methods
Fifty-two patients (median age 62 years) were treated with radical chemoradiotherapy (mitomycin C, infusional 5-fluorouracil concurrently with conformal radical radiotherapy 45 Gy in 25 fractions over 5 weeks) followed by a radiotherapy boost between 1 December 2000 and 30 April 2011. Follow-up was to 30 November 2014. Thirty-six patients received a boost (15–20 Gy) over 2 days with
192
Ir needle brachytherapy for anal canal tumours, and 16 patients received electron beam therapy (20 Gy in 10 fractions in 2 weeks) for anal margin tumours. A defunctioning stoma was only created prior to chemoradiotherapy for fistula or severe anal pain.
Results
The overall survival for the 36 patients treated with chemoradiotherapy followed by brachytherapy was 75 % (95 % CI, 61–89) at 5 years, the disease-specific survival was 91 % (95 % CI, 81–101 %), and the stoma-free survival was 97 % (95 % CI, 91–103 %) all at 5 years. For the 16 patients treated with an electron boost for anal margin tumours, the 5-year overall survival, disease-specific survival and stoma-free survival were 68 % (95 % CI, 44–92 %), 78 % (95 % CI, 56–100 %) and 80 % (95 % CI, 60–100 %), respectively.
Conclusions
A very low stoma formation rate can be obtained with radical chemoradiotherapy followed by a brachytherapy boost for squamous cell carcinoma of the anal canal but not with an electron boost for anal margin tumours.