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Determinants for local tumour control probability after radiotherapy of anal cancer. Radiother Oncol 2018; 128:380-386. [DOI: 10.1016/j.radonc.2018.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 05/25/2018] [Accepted: 06/02/2018] [Indexed: 12/31/2022]
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Dale JE, Sebjørnsen S, Leh S, Rösler C, Aaserud S, Møller B, Fluge Ø, Erichsen C, Nadipour S, Kørner H, Pfeffer F, Dahl O. Multimodal therapy is feasible in elderly anal cancer patients. Acta Oncol 2017; 56:81-87. [PMID: 27808666 DOI: 10.1080/0284186x.2016.1244356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Many patients are diagnosed with an anal cancer in high ages. We here present the outcome after oncological therapy for patients above 80 years compared with younger patients. MATERIALS AND METHODS A series of 213 consecutive patients was diagnosed and treated at a single institution from 1984 to 2009. The patients received similar radiation doses but with different techniques, thus progressively sparing more normal tissues. The majority of patients also had simultaneous [5-fluorouracil (5FU) and mitomycin C] or induction chemotherapy (cisplatin and 5FU). The patients were stratified by age above or below 80 years. Despite that the goal was to offer standard chemoradiation treatment to all, the octo- and nonagenarians could not always be given chemotherapy. RESULTS In our series 35 of 213 anal cancer patients were above 80 years. After initial therapy similar complete response was observed, 80% above and 87% below 80 years. Local recurrence rate was also similar in both groups, 21% versus 26% (p = .187). Cancer-specific survival and relative survival were significantly lower in patients above 80 years, 60% and 50% versus 83% and 80%, (p = .015 and p = .027), respectively. CONCLUSION Patients older than 80 years develop anal cancer, but more often marginal tumors. Even in the oldest age group half of the patients can tolerate standard treatment by a combination of radiation and chemotherapy, and obtain a relative survival of 50% after five years. Fragile patients not considered candidates for chemoradiation may be offered radiation or resection to control local disease.
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Affiliation(s)
- Jon Espen Dale
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Sigrun Sebjørnsen
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Sabine Leh
- Gades Institute, Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Cornelia Rösler
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Stein Aaserud
- Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
| | - Bjørn Møller
- Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
| | - Øystein Fluge
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Christian Erichsen
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - Saied Nadipour
- Department of Surgery, Haugesund Hospital, Haugesund, Norway
| | - Hartwig Kørner
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Institute of Clinical Medicine, Faculty of Medicine and Odontology, University of Bergen, Norway
| | - Frank Pfeffer
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
- Institute of Clinical Medicine, Faculty of Medicine and Odontology, University of Bergen, Norway
| | - Olav Dahl
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- Institute of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway
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Leon O, Guren M, Hagberg O, Glimelius B, Dahl O, Havsteen H, Naucler G, Svensson C, Tveit KM, Jakobsen A, Pfeiffer P, Wanderås E, Ekman T, Lindh B, Balteskard L, Frykholm G, Johnsson A. Anal carcinoma - Survival and recurrence in a large cohort of patients treated according to Nordic guidelines. Radiother Oncol 2015; 113:352-8. [PMID: 25499203 DOI: 10.1016/j.radonc.2014.10.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/01/2014] [Accepted: 10/05/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate treatment outcome in a large population-based cohort of patients with anal cancer treated according to Nordic guidelines. MATERIAL Clinical data were collected on 1266 patients with anal squamous cell carcinoma diagnosed from 2000 to 2007 in Sweden, Norway and Denmark. 886 of the patients received radiotherapy 54-64Gy with or without chemotherapy (5-fluorouracil plus cisplatin or mitomycin) according to different protocols, stratified by tumor stage. RESULTS High age, male gender, large primary tumor, lymph node metastases, distant metastases, poor performance status, and non-inclusion into a protocol were all independent factors associated with worse outcome. Among patients treated according to any of the protocols, the 3-year recurrence-free survival ranged from 63% to 76%, with locoregional recurrences in 17% and distant metastases in 11% of patients. The highest rate of inguinal recurrence (11%) was seen in patients with small primary tumors, treated without inguinal irradiation. CONCLUSIONS Good treatment efficacy was obtained with Nordic, widely implemented, guidelines for treatment of anal cancer. Inguinal prophylactic irradiation should be recommended also for small primary tumors.
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Affiliation(s)
- Otilia Leon
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Marianne Guren
- Department of Oncology, Oslo University Hospital, Norway
| | | | | | - Olav Dahl
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | | | - Gisela Naucler
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Christer Svensson
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Per Pfeiffer
- Department of Oncology, Odense Hospital, Denmark
| | - Eva Wanderås
- Department of Oncology, Oslo University Hospital, Norway
| | - Tor Ekman
- Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Birgitta Lindh
- Department of Oncology, Norrland University Hospital, Umeå, Sweden
| | - Lise Balteskard
- Centre for Clinical Documentation and Evaluation, Northern Regional Health Authority, Tromsö, Norway
| | - Gunilla Frykholm
- Department of Oncology, St. Olav's University Hospital, Trondheim, Norway
| | - Anders Johnsson
- Department of Oncology, Skåne University Hospital, Lund, Sweden.
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Matzinger O, Roelofsen F, Mineur L, Koswig S, Van Der Steen-Banasik EM, Van Houtte P, Haustermans K, Radosevic-Jelic L, Mueller RP, Maingon P, Collette L, Bosset JF. Mitomycin C with continuous fluorouracil or with cisplatin in combination with radiotherapy for locally advanced anal cancer (European Organisation for Research and Treatment of Cancer phase II study 22011-40014). Eur J Cancer 2009; 45:2782-91. [PMID: 19643599 DOI: 10.1016/j.ejca.2009.06.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 06/24/2009] [Indexed: 01/11/2023]
Abstract
PURPOSE To assess the feasibility and activity of radio-chemotherapy with mitomycin C (MMC) and cisplatin (CDDP) in locally advanced squamous cell anal carcinoma with reference to radiotherapy (RT) combined with MMC and fluorouracil (5-FU). PATIENTS AND METHODS Patients with measurable disease >4 cmN0 or N+ received RT (36Gy+2 week gap+23.4Gy) with either MMC/CDDP or MMC/5-FU (MMC 10mg/m(2) d1 of each sequence; 5-FU 200mg/m(2)/day c.i.v. daily; CDDP 25mg/m(2) weekly). Forty patients/arm were needed to exclude a RECIST objective response rate (ORR), 8 weeks after treatment, of <75% (Fleming 1, alpha=10%, beta=10%). RESULTS The ORR was 79.5% (31/39) (lower bound confidence interval [CI]: 68.8%) with MMC/5-FU versus 91.9% (34/ 37) (lower bound CI: 82.8%) with MMC/CDDP. In the MMC/5-FU group, two patients (5.1%) discontinued treatment due to toxicity versus 11 (29.7%) in the MMC/CDDP group. Nine grade 3 haematological events occurred with MMC/CDDP versus none with 5-FU/MMC. The rate of other toxicities did not differ. There was no toxic death. Thirty-one patients in the MMC/5-FU arm (79.5%) and 18 in the MMC/CDDP arm (48.6%) were fully compliant with the protocol treatment (p=0.005). CONCLUSIONS Radio-chemotherapy with MMC/CDDP seems promising as only MMC/CDDP demonstrated enough activity (RECIST ORR >75%) to be tested further in phase III trials; MMC/5-FU did not. MMC/CDDP also had an overall acceptable toxicity profile.
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Ragnarsson-Olding BK, Nilsson PJ, Olding LB, Nilsson BR. Primary ano-rectal malignant melanomas within a population-based national patient series in Sweden during 40 years. Acta Oncol 2009; 48:125-31. [PMID: 18607861 DOI: 10.1080/02841860802120861] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To analyze 251 patients (101 males and 150 females) diagnosed with ano-rectal malignant melanoma (ARMM) reported to the Swedish National Cancer Registry during 1960-1999. METHODS Incidence, gender and age profiles, primary anatomical sites and density of the melanomas along with geographic distribution, and prognosis were investigated. RESULTS The age-standardized incidence of ARMM was significantly higher for females (1.0 per 10(6) females) than for males (0.7 per 10(6) males) throughout the 40-year-period. The incidence increased with age peaking at 75-84 years in both genders. 54% of the tumours were primary in the anal canal, 24% engaged the whole ano-rectal unit and 10% were located at the anal verge (11% unknown primary site). Although ARMM were rare in absolute numbers, their density (number of tumours/square unit) was higher than that of cutaneous malignant melanomas (CMM) on average. No linkage between the geographic distribution of ARMM and population density was found. The prognosis was very poor albeit with a significant gender difference with a five-year survival rate of 10.6% for males and 15.7% for females. The survival rates for both genders improved during the 40-year-period but significantly more for females than males. CONCLUSION The reason(s) for the difference in incidence and prognosis according to gender is unknown. The majority of ARMM emerged primary in the anal canal and a primary location exclusively in the colonic mucosa of the rectum is questionable. The higher density of ARMM as compared to the average density of CMM tallies with the result of our previous studies on vulvar melanoma and might be instrumental in exploring non-UV light associated factors in melanoma genesis. The concentration of patients with anal squamous cell carcinoma to population-dense urban areas, as previously reported, was not found in cases of ARMM.
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