Abstract
Objectives
The aim of this study was to retrospectively evaluate clinical characteristics, local control, acute and late toxicity, and prognostic factors of patients with anal canal carcinoma treated with brachytherapy.
Methods
From 1989 to 2009, 38 patients were treated with iridium 192 low-dose-rate (N=26) or pulsed-dose-rate (N=12) interstitial brachytherapy at a single institution. The median age was 62 years (range, 38–86 years). The TNM classification was as follows: 10 T1, 22 T2, 5 T3 and 1 T4; 32 N0, 3 N1 and 3 N2. Most patients (32/38) received either a first course of radiochemotherapy (N=22) or radiotherapy alone (N=10) consisting of a total delivered dose of 45 Gy to the pelvis (range, 32–50) followed by a boost a median of 18 days later of 15–35 Gy (median 20 Gy) to the anal canal. The remaining 6 cases were treated with brachytherapy alone (dose range, 60–65 Gy).
Results
With a median follow-up of 30 months (range, 4–200), 2- and 5-year local control rates were 91% and 87%, respectively. Preservation of the anal sphincter was achieved in 32 patients (84%). Three patients experienced incontinence after brachytherapy. Only 2 patients showed chronic mucositis grade 3/4. Age proved to be a statistically significant prognostic factor for overall survival in the univariate (p=0.033) and multivariate analyses (p=0.018). Concurrent chemotherapy with external beam radiotherapy was a statistically significant prognostic factor for disease-free survival in the univariate and multivariate analyses (p=0.007 and p=0.044, respectively).
Conclusions
Interstitial brachytherapy appears to be an effective and well tolerated treatment for anal carcinoma offering both high local tumour control and anal sphincter preservation.
Similar content being viewed by others
References
Fleshner PR, Chalasani S, Chang GJ et al (2008) Standards Practice Task Force, American Society of Colon and Rectal Surgeons. Practice parameters for anal squamous neoplasms. Dis Colon Rectum 51:2–9
Jemal A, Siegel R, Ward E et al (2007) Cancer statistics, 2007. CA Cancer J Clin 57:43–66
Arnott SJ, Cunningham D, Gallagher J et al (1996) Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone vs. radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR anal cancer trial working party. UK Coordinating committee on cancer research. Lancet 348:1049–1054
Bartelink H, Roelofsen F, Eschwege F et al (1997) 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 Oncol 15:2040–2049
Cummings BJ, Keane TJ, O’sullivan B et al (1991) Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C. Int J Radiat Oncol Biol Phys 21:1115–1125
Flam M, John M, Pajak TF et al (1996) 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 14:2527–2539
Ng Ying Kin NY, Pigneux J, Auvray H et al (1988) Our experience of conservative treatment of anal canal carcinoma combining external irradiation and interstitial implant: 32 cases treated between 1973 and 1982. Int J Radiat Oncol Biol Phys 14:253–259
Nigro ND, Vaitkevicius VK, Considine Jr B (1974) Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum 17:354–356
Ortholan C, Ramaioli A, Peiffert D et al (2005) Anal canal carcinoma: early-stage tumors < or = 10 mm (T1 or Tis): therapeutic options and original pattern of local failure after radiotherapy. Int J Radiat Oncol Biol Phys 62:479–485
Wang Y, Cummings B, Catton P et al (2005) Primary radical external beam radiotherapy of rectal adenocarcinoma: long term outcome of 271 patients. Radiother Oncol 77:126–132
Gerard JP, Mauro F, Thomas L et al (1999) Treatment of squamous cell anal canal carcinoma with pulsed-dose rate brachytherapy. Feasibility study of a French cooperative group. Radiother Oncol 51:129–131
Greene FL, Page DL, Fleming ID et al (eds) (2002) Lung. In: AJCC Cancer Staging Manual, 6th edn. Springer, New York, NY, pp 167–177
WHO (1979) WHO handbook for reporting results of cancer treatment. World Health Organization, Geneva, Switzerland, Offset Publication No. 48
Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst 92:205–216
Cox JF, Stetz J, Pajak TK (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346
Kaplan EL, Meier P (1958) Non-parametric estimation from incomplete observations. J Am Stat Assoc 53:457–481
Deo SV, Schukla NK, Raina V et al (2005) Organ-preserving multimodality management of squamous cell carcinoma of anal canal. Indian J Gastroenterol 24:201–204
Peiffert D, Giovannini M, Ducreux M et al (2001) High-dose radiation therapy and neoadjuvant plus concomitant chemotherapy with 5-FU and cisplatin in patients with locally advanced squamous cell anal cancer: final results of phase II study. Ann Oncol 12:397–404
Cummings BJ (2001) Anal cancer. Prognostic factors in cancer. Wiley-Liss, New York, pp 281–296
UKCCCR Anal Cancer Trial Working Party (1996) Epidermoid anal cancer: results from the UKCCCR randomized trial of radiotherapy alone vs. radiotherapy, 5-fluorouracil and mitomycin. Lancet 348:1049–1054
Hannoun-Levi JM, Ortholan CC, Resbeut M et al (2010) High-dose split-course radiation therapy for anal cancer: outcome analysis regarding the boost strategy (CORS-03 study). Int J Radiat Oncol Biol Phys (in press)
Myerson RJ, Kong F, Birnbaum EH et al (2001) Radiation therapy for epidermoid carcinoma of the anal canal: clinical and treatment factors associated with outcome. Radiother Oncol 61:15–22
Oehler-Jänne C, Seifert B, Lütolf UM et al (2007). Clinical outcome after treatment with a brachytherapy boost versus external beam boost for anal carcinoma. Brachytherapy 6:218–226
Corner C, Bryant L, Chapman C et al (2010). High-dose-rate afterloading intraluminal brachytherapy for advanced inoperable rectal carcinoma. Brachytherapy 9:66–70
Ferrigno R, Nakamura RA, Ribeiro PE et al (2005) Radiochemotherapy in the conservative treatment of anal canal carcinoma: retrospective analysis of the results and radiation dose effectiveness. Int J Radiat Oncol Biol Phys 61:1136–1142
Mitchell SE, Mendenhall WM, Zlotecki RA et al (2001) Squamous cell carcinoma of the anal canal. Int J Radiat Oncol Biol Phys 45:1007–1013
Widder J, Kastenberger R, Fercher E et al (2008) Radiation dose associated with local control in advanced anal cancer: retrospective analysis of 129 patients. Radiother Oncol 87:367–375
Gerard JP, Ayzac L, Hun D et al (1998) Treatment of anal canal carcinoma with high dose radiation therapy and concomitant fluorouracil-cisplatinum: long-term results in 95 patients. Radiother Oncol 46:249–256
Smaniotto D, Manfrida IS, Luzi S et al (2001) Epidermoid carcinoma of the anal canal. Experience with split-course chemoradiation and 192 Ir low-dose-rate brachytherapy boost [Abstract]. Radiother Oncol 60:S37
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
López Guerra, J.L., Lozano, A.J., Pera, J. et al. Twenty-year experience in the management of squamous cell anal canal carcinoma with interstitial brachytherapy. Clin Transl Oncol 13, 472–479 (2011). https://doi.org/10.1007/s12094-011-0684-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12094-011-0684-z