for localized T1N0 squamous cell carcinoma of the anus (SCCA) standard radiotherapy (RT) may result in overtreatment and alternative strategies are debated.
T1N0M0 SCCA treated between 2015 and 2020 by local excision (LE) or RT were analyzed from the French prospective FFCD ANABASE cohort. Treatment strategies, recurrence-free and colostomy-free survivals (RFS, CFS) and prognostic factors were reported.
among 1135 SCCA patients, 99 T1N0M0 were treated by LE(n = 17,17.2%), or RT (n = 82,82.8%) including RT alone (n = 65,79.2%) or chemo-RT (n = 17, 20.7%). Median follow-up was 27.2 months [0.03–54.44]. Median tumor size were 11.4 mm [0.9–20] and 15.3 mm [2–20] in the LE and RT groups respectively. Mean RT tumor dose was 59.4 Gy [18–69.4 Gy]. One patient in LE group and 9 in RT group had a pelvic recurrence, either local (60%), nodal (10%) or both (30%). RFS and CFS at 24 months were 92.2%[95%CI,83.4–96.4] and 94.6%[95%CI,86.1–98.0], at 36 months 88.1%[95%CI,77.1–94.2] and 88.5%[95%CI,77.0–94.5], in LE and RT group respectively, without any significative difference (HR = 0.57;[95%CI,0.07–4.45];p = 0.60). By univariate analysis, male gender was the only prognostic factor(HR = 5.57;95%CI, 1.76–17.63; p = 0.004).
this cohort confirms the heterogeneity of T1N0M0 SCCA management, questioning the place of RT alone, reduced dose or RT volume, and the safety of LE.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Digestive and Liver Disease
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Anal cancer: French intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SNFCP).Dig Liver Dis. 2017; 49: 831-840https://doi.org/10.1016/j.dld.2017.05.011
- Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis.Int J Cancer. 2009; 124: 1626-1636https://doi.org/10.1002/ijc.24116
- International trends in anal cancer incidence rates.Int J Epidemiol. 2017; 46: 924-938https://doi.org/10.1093/ije/dyw276
- Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups.J Clin Onco J Am Soc Clin Oncol. 1997; 15: 2040-2049https://doi.org/10.1200/JCO.1918.104.22.1680
- Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study.J Clin Oncol J Am Soc Clin Oncol. 1996; 14: 2527-2539https://doi.org/10.1200/JCO.1922.214.171.1247
- Epidermoid anal cancer: results from the UKCCCR randomized trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin.Lancet. 1996; 348: 1049-1054
- Combined therapy for cancer of the anal canal: a preliminary report.Dis Colon Rectum. 1974; 17: 354-356https://doi.org/10.1007/BF02586980
- Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomized UKCCCR Anal Cancer Trial (ACT I).Br J Cancer. 2010; 102: 1123-1128https://doi.org/10.1038/sj.bjc.6605605
- Combined treatment of squamous cell carcinoma of the anal canal: radical radiation therapy with 5-fluorouracil and mitomycin-C, a preliminary report.Dis Colon Rectum. 1980; 23: 389-391https://doi.org/10.1007/BF02586784
- The development of an umbrella trial (PLATO) to address radiation therapy dose questions in the locoregional management of squamous cell carcinoma of the anus.Int J Radiat Oncol Biol Phys. 2016; 96: E164-E165https://doi.org/10.1016/j.ijrobp.2016.06.1006
Common Terminology Criteria for Adverse Events (CTCAE) 2017:155.
- Nonparametric estimation from incomplete observations.J Am Stat Assoc. 1958; 53: 457-481https://doi.org/10.1080/01621459.1958.10501452
- Epidermoid carcinoma of the anal canal. Results of curative-intent radiation therapy in a series of 270 patients.Cancer. 1994; 73 (. 10.1002/1097-0142(19940315)73:61569::aid-cncr28207306073.0.co;2-f): 1569-1579
- Radiation therapy for epidermoid carcinoma of the anal canal, clinical and treatment factors associated with outcome.Radiother Oncol J Eur Soc Ther Radiol Oncol. 2001; 61: 15-22https://doi.org/10.1016/s0167-8140(01)00404-2
- Anal cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up.Ann Oncol. 2014; 25: 10-20https://doi.org/10.1093/annonc/mdu159
- The Role of FDG-PET in the initial staging and response assessment of anal cancer: a systematic review and meta-analysis.Ann Surg Oncol. 2015; 22: 3574-3581https://doi.org/10.1245/s10434-015-4391-9
- Epidermoid carcinoma of the anorectum.Surg Gynecol Obstet. 1970; 131: 953-957
- Malignant tumors of the anal canal.Cancer. 1999; 85 (. 10.1002/(SICI)1097-0142(19990415)85:81686::AID−CNCR73.0.CO;2-7): 1686-1693
- Clinical and economic evaluation of treatment strategies for T1N0 anal canal cancer: am.J Clin Oncol. 2018; 41: 626-631https://doi.org/10.1097/COC.0000000000000339
- Management of stage I squamous cell carcinoma of the anal canal.JAMA Surg. 2018; 153: 209https://doi.org/10.1001/jamasurg.2017.3151
- Primary surgery with or without postoperative radiotherapy in early stage squamous cell carcinoma in the anal canal and anal margin.Acta Oncol. 2018; 57: 1209-1215https://doi.org/10.1080/0284186X.2018.1442931
- Node-negative T1–T2 anal cancer: radiotherapy alone or concomitant chemoradiotherapy?.Radiother Oncol. 2012; 102: 62-67https://doi.org/10.1016/j.radonc.2011.09.015
- Could concomitant radio-chemotherapy improve the outcomes of early-stage node negative anal canal cancer patients? A retrospective analysis of 122 patients.Cancer Invest. 2015; 33: 114-120https://doi.org/10.3109/07357907.2014.1001898
- Conservative treatment by irradiation of epidermoid cancers of the anal canal: prognostic factors of tumoral control and complications.Int J Radiat Oncol. 1997; 37: 313-324https://doi.org/10.1016/S0360-3016(96)00493-2
- Radiothérapie des cancers du canal anal.Cancer/Radiothérapie. 2016; 20: S183-S188https://doi.org/10.1016/j.canrad.2016.07.061
- Definitive irradiation and chemotherapy for radiosensitization in management of anal carcinoma: interim report on radiation therapy oncology group study No. 8314.JNCI J Natl Cancer Inst. 1989; 81: 850-857https://doi.org/10.1093/jnci/81.11.850
- Involved-field, low-dose chemoradiotherapy for early-stage anal carcinoma.Int J Radiat Oncol. 2008; 70: 419-424https://doi.org/10.1016/j.ijrobp.2007.06.072
- Evaluation of a 36Gy elective node irradiation dose in anal cancer.Radiother Oncol. 2015; 116: 197-201https://doi.org/10.1016/j.radonc.2015.07.050
- Anal canal carcinoma: early-stage tumors ≤10mm (T1 or Tis): therapeutic options and original pattern of local failure after radiotherapy.Int J Radiat Oncol. 2005; 62: 479-485https://doi.org/10.1016/j.ijrobp.2004.09.060
- Elective clinical target volumes for conformal therapy in anorectal cancer: a radiation therapy oncology group consensus panel contouring atlas.Int J Radiat Oncol. 2009; 74: 824-830https://doi.org/10.1016/j.ijrobp.2008.08.070
- Australasian gastrointestinal trials group (AGITG) contouring atlas and planning guidelines for intensity-modulated radiotherapy in anal cancer.Int J Radiat Oncol. 2012; 83: 1455-1462https://doi.org/10.1016/j.ijrobp.2011.12.058
- Anal canal cancer: management of inguinal nodes and benefit of prophylactic inguinal irradiation (CORS-03 Study).Int J Radiat Oncol. 2012; 82: 1988-1995https://doi.org/10.1016/j.ijrobp.2011.02.010
- 30Gy may be an adequate dose in patients with anal cancer treated with excisional biopsy followed by combined-modality therapy.J Surg Oncol. 1999; 70: 71-77
- Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomized, phase 3, open-label, 2 × 2 factorial trial.Lancet Oncol. 2013; 14: 516-524https://doi.org/10.1016/S1470-2045(13)70086-X
Published online: April 16, 2021
Accepted: March 12, 2021
Received: November 10, 2020
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.