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Strahlentherapie und Onkologie

, Volume 195, Issue 5, pp 369–373 | Cite as

Chemoradiotherapy for anal cancer: are we as good as we think?

  • D. MartinEmail author
  • C. Rödel
  • E. Fokas
Review Article
  • 198 Downloads

Abstract

Definitive chemoradiotherapy (CRT) is the standard treatment for anal squamous cell carcinoma (ASCC). Data regarding treatment outcome according to TNM classification is scarce. Here, we review data of randomized trials and retrospective cohorts suggesting a poor 3‑year disease-free survival (DFS; or progression-free survival, PFS) of approximately 60%, or even lower, in patients with locally advanced T3–4 and/or N+ disease, while patients with T1–2N0 ASCC have 3‑year DFS/PFS rates exceeding 80%. These results are in line with our data in a cohort of 210 patients with ASCC treated with definitive 5‑fluorouracil/mitomycin C‑based CRT to a total dose of 50.4 Gy plus a boost of 3.6–10.8 Gy. The implications of these findings and the current trials testing radiotherapy dose escalation/de-escalation strategies are reported. Finally, we will discuss the strong rationale for testing immune checkpoint blockade (ICB) with CRT in clinical trials to improve results, especially in patients with advanced ASCC.

Keywords

Stage Outcome Prognosis Lymph nodes Chemotherapy 

Radiochemotherapie für das Analkarzinom: Sind wir so gut, wie wir denken?

Zusammenfassung

Die Radiochemotherapie (RCT) ist die Standardbehandlung für das Analkarzinom, es gibt allerdings nur wenige publizierte Daten zu Behandlungsergebnissen aufgeschlüsselt nach TNM-Kategorien. Die hier zusammengefassten Daten aus randomisierten Studien und retrospektiven Auswertungen belegen ein schlechtes krankheitsfreies (DFS) oder progressionsfreies Überleben (PFS) von etwa nur 60% oder niedriger nach 3 Jahren für Patienten mit lokal fortgeschrittenen Analkarzinomen im Stadium T3–4 und/oder N+. Demgegenüber zeigen Patienten im Stadium T1–2N0 ein 3‑Jahres-DFS/-PFS von über 80%. Diese Daten korrespondieren mit den Ergebnissen aus unserer Klinik an 210 Patienten mit Analkarzinom, welche mit definitiver RCT mit 5‑Fluoruracil/Mitomycin C bis zu einer Gesamtdosis von 50,4 Gy plus Boost von 3,6–10,8 Gy behandelt wurden. Die Bedeutung dieser Daten im Kontext aktuell laufender Studien zu Eskalations- und Deeskalationsstrategien wird aufgezeigt. Schließlich diskutieren wir, warum die Hinzunahme von Immun-Checkpoint-Inhibitoren zur RCT eine deutliche Verbesserung der Behandlungsergebnisses insbesondere für lokal fortgeschrittene Analkarzinome bewirken könnte.

Schlüsselwörter

Stadium Therapieergebnis Prognose Lymphknoten Chemotherapie 

Notes

Compliance with ethical guidelines

Conflict of interest

D. Martin, C. Rödel and E. Fokas declare that they have no competing interests.

Ethical standards

All human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiotherapy and OncologyGoethe-University Frankfurt am MainFrankfurt am MainGermany
  2. 2.German Cancer Research Center (DKFZ)HeidelbergGermany
  3. 3.partner site: Frankfurt a. M.German Cancer Consortium (DKTK)Frankfurt a. M.Germany

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