Treatment, outcome, and prognostic factors in non-metastatic anal cancer: The French nationwide cohort study FFCD-ANABASE

• Published in: Radiotherapy and oncology 2023-06, Vol.183, p.109542-109542, Article 109542
• Main Authors: VENDRELY, Véronique, LEMANSKI, Claire, POMMIER, Pascal, LE MALICOT, Karine, SAINT, Angélique, RIVIN DEL CAMPO, Eleonor, REGNAULT, Pauline, BABA-HAMED, Nabil, RONCHIN, Philippe, CREHANGE, Gilles, TOUGERON, David, MENAGER-TABOUREL, Elodie, DIAZ, Olivia, HUMMELSBERGER, Michael, MINSAT, Mathieu, DROUET, Franck, LARROUY, Anne, PEIFFERT, Didier, LIEVRE, Astrid, ZASADNY, Xavier, HAUTEFEUILLE, Vincent, MORNEX, Françoise, LEPAGE, Côme, QUERO, Laurent
• Format: Article
• Language: English
• Subjects: Aged; Anal cancer; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Anus Neoplasms - drug therapy; Cancer; Carcinoma, Squamous Cell - drug therapy; Chemoradiotherapy; Chemoradiotherapy - methods; Cohort Studies; Female; Fluorouracil; Humans; IMRT; Life Sciences; Male; Mitomycin; Observational cohort; Prognosis; Prospective Studies; Radiotherapy, Intensity-Modulated - methods; Treatment Outcome
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2023.109542

•The treatment of patients from the FFCD-ANABASE cohort showed good respect for the current guidelines for anal cancer treatment, and a good implementation of IMRT in France in this indication.•Two-thirds of patients with treatment interruption for toxicity were not treated with IMRT but 3D conformal RT. Conversely, IMRT was significantly associated with a better CFS.•In multivariate analyses, male gender, locally-advanced stage, and ECOG PS ≥ 1 were associated with poorer DFS, CFS, and OS.•Significant differences in DFS, CFS, and OS between early-stage group (T1-2, N0) and locally-advanced group (T3-4, or N + ) advocate for personalized strategies by either de-escalation for early-stage tumors or treatment intensification for locally-advanced tumors. International guidelines regarding the treatment of squamous cell carcinoma of the anus (SCCA) recommend intensity-modulated radiotherapy (IMRT) combined with mitomycin-based chemotherapy (CT). The French FFCD-ANABASE cohort aimed at evaluating clinical practices, treatment, and outcomes of SCCA patients. This prospective multicentric observational cohort included all non-metastatic SCCA patients treated in 60 French centers from January 2015 to April 2020. Patients and treatment characteristics, colostomy-free survival (CFS), disease-free survival (DFS), overall survival (OS), and prognostic factors were analyzed. Among 1015 patients (male: 24.4 %; female: 75.6 %; median age: 65 years), 43.3 %presented with early-stage(T1-2, N0) and 56.7 % with locally advanced stage (T3-4 or N + ) tumors. IMRT was used for 815 patients (80.3 %) and a concurrent CT was administered in 781 patients, consisting of mitomycin-based CT for 80 %. The median follow-up was 35.5 months. DFS, CFS, and OS at 3 years were 84.3 %, 85.6 %, and 91.7 % respectively in the early-stage group compared to 64.4 %, 66.9 %, and 78.2 % in the locally-advanced group (p