Radiotherapy alone versus chemoradiotherapy for stage I anal squamous cell carcinoma: a systematic review and meta-analysis

Background: Patients with stage I anal squamous cell carcinoma (SCC) have been underrepresented in landmark trials showing superiority of chemoradiotherapy (CRT) over radiotherapy alone (RT) for definitive treatment. This review aimed to elucidate whether definitive treatment with RT versus CRT is a...

Full description

Saved in:
Bibliographic Details
Published in:Canadian Journal of Surgery 2021-12, Vol.64, p.S127-S127
Main Authors: Talwar, G, Daniel, R, McKechnie, T, Levine, O, Eskicioglu, C
Format: Article
Language:English
Subjects:
Chemotherapy
Colorectal cancer
Meta-analysis
Radiation therapy
Squamous cell carcinoma
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background: Patients with stage I anal squamous cell carcinoma (SCC) have been underrepresented in landmark trials showing superiority of chemoradiotherapy (CRT) over radiotherapy alone (RT) for definitive treatment. This review aimed to elucidate whether definitive treatment with RT versus CRT is associated with differences in survival and treatment-related toxicity outcomes in patients with stage I anal SCC. Methods: Medline, Embase and Central were searched as of November 2020 to identify studies comparing outcomes of RT versus CRT for nonoperative treatment of patients with stage I anal SCC. The primary outcomes were 5-year overall survival (OS) and 5-year disease-free survival (DFS). The secondary outcome was treatment-related toxicities. A pairwise meta-analysis was performed using an inverse-variance random-effects model. Results: From 2174 citations, 5 retrospective studies with 415 patients treated with RT and 3784 patients treated with CRT were included. Patients treated with CRT had an increased 5-year OS (relative risk [RR] 1.18, 95% confidence interval [CI] 1.10-1.26, p < 0.001, I2 0%) but no significant difference in 5-year DFS (RR 1.01, 95% CI 0.92- 1.11, p = 0.87, I2 0%). Treatment-related toxicities could not be meta-analyzed because of heterogeneity. Limited data from individual studies suggested an increased frequency of select toxicities with CRT. Conclusion: RT may be an appropriate alternative to CRT for patients with stage I anal SCC who may be unable to tolerate chemotherapy-related toxicity; however, CRT remains the gold standard. Larger prospective studies comparing strategies for this select patient population are needed to clarify whether treatment can be de-escalated.
ISSN:0008-428X
1488-2310