Is neoadjuvant chemotherapy prior to radio-chemotherapy beneficial in T4 anal carcinoma?

• Published in: Journal of surgical oncology 2011-07, Vol.104 (1), p.66-71
• Main Authors: Moureau-Zabotto, L., Viret, F., Giovaninni, M., Lelong, B., Bories, E., Delpero, J.R., Pesenti, C., Caillol, F., de Chaisemartin, C., Minsat, M., Monges, G., Sarran, A., Resbeut, M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Anus Neoplasms - drug therapy; Anus Neoplasms - radiotherapy; Anus Neoplasms - therapy; Brachytherapy; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - therapy; Chemotherapy, Adjuvant; Cisplatin - administration & dosage; Cohort Studies; Combined Modality Therapy; exclusive radio-chemotherapy; Female; Fluorouracil - administration & dosage; Humans; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Retrospective Studies; Survival Rate; T4 anal carcinoma; Treatment Outcome
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.21866

Background This study retrospectively describes the outcome of a series of 38 patients (pts) with T4 anal carcinoma exclusively treated by radio and chemotherapy. Patients and Methods From 1992 to 2007, 38 pts with UST4‐N0‐2‐M0 anal carcinoma were treated with exclusive radiotherapy and chemotherapy. All patients received external beam radiotherapy (EBRT) (median dose 45 Gy) with a concomitant chemotherapy (5‐fluorouracil‐cisplatin). Eleven patients received neo‐adjuvant chemotherapy (5‐fluorouracil‐cisplatin). After 2–8 weeks, a 15–20 Gy boost was delivered either with EBRT (20 pts) or interstitial 192Ir brachytherapy (18 pts). Mean follow‐up was 66 months. Results After chemoradiation therapy (CRT), 13 pts (34%) had a complete response, 23 pts (60%) a response >50% (2 pts were not evaluated). The 5‐year‐disease‐free survival was 79.2 ± 6.5%, and the 5‐year overall survival was 83.9 ± 6%. Eight patients developed tumor progression (mean delay 8.8 months), six of them requiring a salvage surgery with definitive colostomy for local relapse. Late severe complication requiring colostomy was observed in 2 pts. The 5‐year‐colostomy‐free survival was 78 ± 6.9%. Patients who received primary chemotherapy had a statistically significant better 5‐year colostomy‐free survival (100% vs. 38 ± 16.4%, P = 0.0006). Conclusion T4 anal carcinoma can be treated with a curative intent using a sphincter‐sparing approach of CRT, and neo‐adjuvant chemotherapy should be considered prior to radiotherapy. J. Surg. Oncol. 2011;104:66–71. © 2011 Wiley‐Liss, Inc.