Management Of Anal Cancer
  • Combined Radiation/Chemotherapy is standard.
  • Chemotherapy is 5FU&Mitomycin C

Key Studies

Studies showed benefit in adding chemo to Rad:

  • UKCCR
  • EORTC
  • Both showed improvement in local control and colostomy-free survival
    • 10-20% increase in 3yr LR
    • From ~40% in Rad alone —> ~50-60% in CRT
  • UKCCR also showed cause specific survival
    • 3yr CSS
      • ~60% —> ~70%
  • None showed OS survival

UKCCR

  • SCC
  • Anal Canal and anal margin
  • Arms —> RT vs CRT
    • RT —> 45 Gy in 20-25fr in 4 to 5 weeks
    • Chemo —>
      • 5-FU (1,000 mg/m2/day for 4 days or 750 mg/m2/day for 5 days) by continuous peripheral intravenous infusion in the first and final weeks of radiation treatment
      • Mitomycin (12 mg/m2) by bolus intravenous injection on day 1 of the first course of chemotherapy
  • Many had locally advanced primary tumour
    • 40% —> >5 cm in size (T3) or deeply invasive (T4)
    • 20% —> LN+
    • 2% —> extrapelvic metastases
  • Locoregional failure defenition in UKCCR:
    • Residual or recurrent cancer in the primary site or regional nodes
    • Treatment-related morbidity requiring surgery
    • Inability to close a colostomy opened prior to treatment
  • Hematologic toxicity more in CRT group

Results:

  • Reduce Risk of LR by 46%
    • absolute difference ~25%
      • 10yr LR failure:
        • RT: 35%, vs CRT: 60%
  • Relapse free survival
    • Absolute difference reached to 12% at 5 years and stayed the same till 12 years
      • 12yr —> 18% vs 30%
  • Colostomy free survival
    • After 12years —> Absolute benefit : 10%
      • 20% vs 30%
  • OS
    • 10yr OS ~40% both
    • 5yr OS ~55% both
    • CMT slightly better; NS

EORTC