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English KJ. Anal carcinoma - exploring the epidemiology, risk factors, pathophysiology, diagnosis, and treatment. World J Exp Med 2024; 14:98525. [DOI: 10.5493/wjem.v14.i3.98525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/15/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024] Open
Abstract
Anal carcinoma is a relatively rare tumor that accounts for approximately 2% of gastrointestinal malignancies and less than 7% of anorectal cancers. Most anal tumors originate between the anorectal junction and the anal verge. Risk factors for the disease include human papillomavirus infection, human immunodeficiency virus, tobacco use, immunosuppression, female sex, and older age. The pathogenesis of anal carcinoma is believed to be linked to human papillomavirus-related inflammation, leading to dysplasia and progression to cancer. Squamous cell carcinoma is the most common type of anal tumor, with an annual incidence of approximately 1 to 2 per 100000 persons. Treatment regarding anal cancer has emerged over time. However, chemoradiation therapy remains the mainstay approach for early localized disease. Patients with metastatic disease are treated with systemic therapy, and salvage surgery is reserved for disease recurrence following chemoradiation. This article aims to provide background information on the epidemiology, risk factors, pathology, diagnosis, and current trends in the management of anal cancer. Future directions are briefly discussed.
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Affiliation(s)
- Kevan J English
- Department of Medicine, Division of Gastroenterology & Hepatology, Saint George’s University School of Medicine, Saint George 33334, Saint George, Grenada
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Zheng A, Wang Y, Li S, Wang Y, Xu H, Ding J, Chen B, Song T, Lai L. Comparison of the TNM9th and 8th editions for localized and locally advanced anal squamous cell carcinoma treated nonsurgically and proposal of a new stage grouping system. Cancer Med 2024; 13:e70119. [PMID: 39158000 PMCID: PMC11331335 DOI: 10.1002/cam4.70119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/18/2024] [Accepted: 08/06/2024] [Indexed: 08/20/2024] Open
Abstract
OBJECTIVE To compare the survival discrimination of the TNM9th and 8th editions for localized and locally advanced anal squamous cell carcinoma (ASCC) treated nonsurgically and suggest a simple revised staging system with data from the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Overall survival (OS) was the primary endpoint. Survival comparisons between the T and N stages and the different staging systems were performed using the Kaplan-Meier method and log-rank test, followed by correlation analysis and variable importance analysis (VIA). Additionally, multivariate analysis was employed to identify significant predictors, which were further visualized using a nomogram. Finally, calibration curve, C-index, and decision curve analysis (DCA) were applied to assess the performance of the different staging systems. RESULTS A total of 5384 patients with ASCC were analyzed, revealing superior discrimination OS by the TNM9th edition compared to that by the TNM8th edition. Multivariate analysis identified the T and N stages as significant OS predictors (all p < 0.001). However, ambiguity persisted in stage III subgroups within the TNM9th edition, showing OS times of 102 months for stage IIIA disease, 88 months for stage IIIB disease, and 128 months for stage IIIC disease (all p > 0.05). Correlation analysis demonstrated an increased correlation for the T stage between the TNM8th and 9th editions (ρ value from 0.7 to 0.89), while the N stage correlation decreased (ρ value from 0.84 to 0.56). VIA and the prognostic nomogram highlighted the greater importance of the T stage over the N stage. Based on these findings, a new staging system was developed, and its clinical utility was confirmed through calibration curves, C-index values (from 0.598 to 0.604), and DCAs. CONCLUSIONS Our new staging system exhibited slightly better prognostic value compared to the TNM9th staging systems for nonmetastatic ASCC and warrants further validation.
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Affiliation(s)
- Aihong Zheng
- Cancer Center, Department of Medical OncologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouPeople's Republic of China
| | - Yiwen Wang
- Department of Clinical Medical EngineeringThe Second Affiliated Hospital, Zhejiang University School of MedicineHangzhouPeople's Republic of China
| | - Shuang Li
- Cancer Center, Department of Radiation OncologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouPeople's Republic of China
- Cancer Center, Department of Radiation OncologyZhejiang Provincial People's Hospital, Jinzhou Medical UniversityJinzhouPeople's Republic of China
| | - Yingjie Wang
- Department of OncologyTongxiang First People's HospitalJiaxingPeople's Republic of China
| | - Hong'en Xu
- Cancer Center, Department of Radiation OncologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouPeople's Republic of China
| | - Jieni Ding
- Cancer Center, Department of Radiation OncologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouPeople's Republic of China
| | - Bingchen Chen
- Department of General Surgery, Cancer Center, Division of Colorectal SurgeryZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouPeople's Republic of China
| | - Tao Song
- Cancer Center, Department of Radiation OncologyZhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical CollegeHangzhouPeople's Republic of China
- Department of OncologyTongxiang First People's HospitalJiaxingPeople's Republic of China
| | - Lei Lai
- Department of OncologyTongxiang First People's HospitalJiaxingPeople's Republic of China
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Frood R, Mercer J, Brown P, Appelt A, Mistry H, Kochhar R, Scarsbrook A. Training and external validation of pre-treatment FDG PET-CT-based models for outcome prediction in anal squamous cell carcinoma. Eur Radiol 2024; 34:3194-3204. [PMID: 37924344 PMCID: PMC11126458 DOI: 10.1007/s00330-023-10340-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/20/2023] [Accepted: 08/24/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES The incidence of anal squamous cell carcinoma (ASCC) is increasing worldwide, with a significant proportion of patients treated with curative intent having recurrence. The ability to accurately predict progression-free survival (PFS) and overall survival (OS) would allow for development of personalised treatment strategies. The aim of the study was to train and external test radiomic/clinical feature derived time-to-event prediction models. METHODS Consecutive patients with ASCC treated with curative intent at two large tertiary referral centres with baseline FDG PET-CT were included. Radiomic feature extraction was performed using LIFEx software on the pre-treatment PET-CT. Two distinct predictive models for PFS and OS were trained and tuned at each of the centres, with the best performing models externally tested on the other centres' patient cohort. RESULTS A total of 187 patients were included from centre 1 (mean age 61.6 ± 11.5 years, median follow up 30 months, PFS events = 57/187, OS events = 46/187) and 257 patients were included from centre 2 (mean age 62.6 ± 12.3 years, median follow up 35 months, PFS events = 70/257, OS events = 54/257). The best performing model for PFS and OS was achieved using a Cox regression model based on age and metabolic tumour volume (MTV) with a training c-index of 0.7 and an external testing c-index of 0.7 (standard error = 0.4). CONCLUSIONS A combination of patient age and MTV has been demonstrated using external validation to have the potential to predict OS and PFS in ASCC patients. CLINICAL RELEVANCE STATEMENT A Cox regression model using patients' age and metabolic tumour volume showed good predictive potential for progression-free survival in external testing. The benefits of a previous radiomics model published by our group could not be confirmed on external testing. KEY POINTS • A predictive model based on patient age and metabolic tumour volume showed potential to predict overall survival and progression-free survival and was validated on an external test cohort. • The methodology used to create a predictive model from age and metabolic tumour volume was repeatable using external cohort data. • The predictive ability of positron emission tomography-computed tomography-derived radiomic features diminished when the influence of metabolic tumour volume was accounted for.
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Affiliation(s)
- Russell Frood
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
| | - Joseph Mercer
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Peter Brown
- Department of Radiology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Ane Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Hitesh Mistry
- Division of Pharmacy, University of Manchester, Manchester, UK
| | - Rohit Kochhar
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Andrew Scarsbrook
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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Huang W, Tao Z, Younis MH, Cai W, Kang L. Nuclear medicine radiomics in digestive system tumors: Concept, applications, challenges, and future perspectives. VIEW 2023; 4:20230032. [PMID: 38179181 PMCID: PMC10766416 DOI: 10.1002/viw.20230032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/20/2023] [Indexed: 01/06/2024] Open
Abstract
Radiomics aims to develop novel biomarkers and provide relevant deeper subvisual information about pathology, immunophenotype, and tumor microenvironment. It uses automated or semiautomated quantitative analysis of high-dimensional images to improve characterization, diagnosis, and prognosis. Recent years have seen a rapid increase in radiomics applications in nuclear medicine, leading to some promising research results in digestive system oncology, which have been driven by big data analysis and the development of artificial intelligence. Although radiomics advances one step further toward the non-invasive precision medical analysis, it is still a step away from clinical application and faces many challenges. This review article summarizes the available literature on digestive system tumors regarding radiomics in nuclear medicine. First, we describe the workflow and steps involved in radiomics analysis. Subsequently, we discuss the progress in clinical application regarding the utilization of radiomics for distinguishing between various diseases and evaluating their prognosis, and demonstrate how radiomics advances this field. Finally, we offer our viewpoint on how the field can progress by addressing the challenges facing clinical implementation.
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Affiliation(s)
- Wenpeng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Zihao Tao
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Muhsin H. Younis
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Weibo Cai
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
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Ranabhotu A, Habibian N, Patel B, Farrell E, Do J, Sedghi S, Sedghi L. Case Report: Resolution of high grade anal squamous intraepithelial lesion with antibiotics proposes a new role for syphilitic infection in potentiation of HPV-associated ASCC. Front Oncol 2023; 13:1226202. [PMID: 37854673 PMCID: PMC10580285 DOI: 10.3389/fonc.2023.1226202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/04/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Human Papillomavirus (HPV) is the primary risk factor for the development of anal intraepithelial neoplasia (AIN) and is a leading risk factor for anogenital squamous cell carcinoma (ASCC). Despite common shared risk factors for both HPV and syphilis, co-infection is not well documented, and the role of syphilitic infection in HPV-associated AIN and ASCC potentiation is not defined. Case description/methods A 72-year-old single male presented with complaints of mild rectal pain and intermittent rectal bleeding. A flexible sigmoidoscopy was performed, and a firm 4.5cm x 3cm perianal mass was detected and superficially biopsied. Pathology findings demonstrated evidence of a high grade squamous intraepithelial lesion (HGSIL, AIN II/III/AIS) with viral cytopathic effect, consistent with HPV infection. Much of the biopsied lesion showed acanthotic squamous mucosa with intraepithelial neutrophils and abundant submucosal plasma cells, suggesting possible syphilitic involvement. Subsequent immunohistochemical staining for p16 as a surrogate marker for HPV was positive, as was an immunohistochemical stain for spirochetes, supportive of co-infection with Treponema pallidum pallidum (T. pallidum), the causative agent in venereal syphilis. The patient was referred to an infectious disease specialist for syphilitic infection and was treated with penicillin with surprisingly complete resolution of the lesion. EUAs were performed 2- and 3-months following treatment without lesion recurrence. However, one year following diagnosis, a flexible sigmoidoscopy revealed a 5 mm recurrent HPV-related low-grade AIN 1 lesion at the dentate line. Discussion Resolution of the lesion by antibiotic treatment for syphilitic infection suggested that co-infection by T. pallidum may potentiate HPV-associated squamous cell carcinoma based on histological findings. Findings from this case, as well as a review of bacterial involvement and potentiation in various cancers, are reviewed here. Such findings offer new insight regarding the role of STI-associated bacteria and HPV co-infection in the establishment of AIN and may additionally propose new treatment modalities for ASCC.
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Affiliation(s)
- A. Ranabhotu
- Gatroenterology Associates of Central Georgia, Macon, GA, United States
| | - N. Habibian
- Gatroenterology Associates of Central Georgia, Macon, GA, United States
| | - B. Patel
- Gatroenterology Associates of Central Georgia, Macon, GA, United States
| | - E. Farrell
- Gatroenterology Associates of Central Georgia, Macon, GA, United States
- Mercer University School of Medicine, Macon, GA, United States
| | - J. Do
- Advanced Pathology Solutions, Department of Gastroenterology, Little Rock, AR, United States
| | - S. Sedghi
- Gatroenterology Associates of Central Georgia, Macon, GA, United States
- Mercer University School of Medicine, Macon, GA, United States
| | - L. Sedghi
- Department of Oral and Craniofacial Sciences, University of California San Francisco School of Dentistry, San Francisco, CA, United States
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Roji AM, Namiq KF, Radley S, Ismail T, Hejmadi R, Taniere P, Geh JI. Management of small (T1-T2) anal margin squamous cell carcinoma: clinical outcomes following local excision alone. Colorectal Dis 2023; 25:1403-1413. [PMID: 37029622 DOI: 10.1111/codi.16562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/28/2023] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Abstract
AIM Squamous cell carcinomas of the anus are normally treated with synchronous chemoradiotherapy (CRT). Small, localized anal margin tumours may be adequately treated by local excision (LE) alone. This study aims to investigate the outcomes of patients with anal margin tumours treated with LE alone, reserving the use of CRT for salvage on local recurrence (LR). METHODS Patients with small, localized (stage I/IIA) anal margin tumours treated by LE from October 1999 to September 2018 were identified. The effect of tumour size and resection margin on LR risk was analysed. Outcomes of overall survival and disease-free survival were measured. RESULTS Fifty-five patients with anal margin tumours were identified. Overall 5-year LR, overall survival and disease-free survival rates were 8%, 86% and 82% respectively. Of the seven LRs, five were successfully salvaged with CRT with no further recurrence and two were not fit for CRT. Resection margins in non-fragmented tumours and tumour size did not significantly influence LR risk. CONCLUSIONS Most small, localized anal margin tumours can be adequately treated by LE alone with low LR rates. Most patients who developed LR were salvaged using CRT, with no cancer-related deaths reported.
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Affiliation(s)
- A M Roji
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - K F Namiq
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - S Radley
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T Ismail
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Hejmadi
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Taniere
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J I Geh
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
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Love SB, Cafferty F, Snowdon C, Carty K, Savage J, Pallmann P, McParland L, Brown L, Masters L, Schiavone F, Hague D, Townsend S, Amos C, South A, Sturgeon K, Langley R, Maughan T, James N, Hall E, Kernaghan S, Bliss J, Turner N, Tutt A, Yap C, Firth C, Kong A, Mehanna H, Watts C, Hills R, Thomas I, Copland M, Bell S, Sebag-Montefiore D, Jones R, Parmar MKB, Sydes MR. Practical guidance for running late-phase platform protocols for clinical trials: lessons from experienced UK clinical trials units. Trials 2022; 23:757. [PMID: 36068599 PMCID: PMC9449272 DOI: 10.1186/s13063-022-06680-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 08/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late-phase platform protocols (including basket, umbrella, multi-arm multi-stage (MAMS), and master protocols) are generally agreed to be more efficient than traditional two-arm clinical trial designs but are not extensively used. We have gathered the experience of running a number of successful platform protocols together to present some operational recommendations. METHODS Representatives of six UK clinical trials units with experience in running late-phase platform protocols attended a 1-day meeting structured to discuss various practical aspects of running these trials. We report and give guidance on operational aspects which are either harder to implement compared to a traditional late-phase trial or are specific to platform protocols. RESULTS We present a list of practical recommendations for trialists intending to design and conduct late-phase platform protocols. Our recommendations cover the entire life cycle of a platform trial: from protocol development, obtaining funding, and trial set-up, to a wide range of operational and regulatory aspects such as staffing, oversight, data handling, and data management, to the reporting of results, with a particular focus on communication with trial participants and stakeholders as well as public and patient involvement. DISCUSSION Platform protocols enable many questions to be answered efficiently to the benefit of patients. Our practical lessons from running platform trials will support trial teams in learning how to run these trials more effectively and efficiently.
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Affiliation(s)
- Sharon B. Love
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - Fay Cafferty
- The Institute of Cancer Research, London, SW7 3RP UK
| | | | - Karen Carty
- Cancer Research UK Clinical Trials Unit, Level 0 The Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Joshua Savage
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Philip Pallmann
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | | | - Louise Brown
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - Lindsey Masters
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | | | - Dominic Hague
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - Stephen Townsend
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - Claire Amos
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - Annabelle South
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - Kate Sturgeon
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - Ruth Langley
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | | | | | - Emma Hall
- The Institute of Cancer Research, London, SW7 3RP UK
| | | | - Judith Bliss
- The Institute of Cancer Research, London, SW7 3RP UK
| | - Nick Turner
- The Institute of Cancer Research, London, SW7 3RP UK
| | - Andrew Tutt
- The Institute of Cancer Research, London, SW3 6JB UK
| | - Christina Yap
- The Institute of Cancer Research, London, SW7 3RP UK
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Charlotte Firth
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Anthony Kong
- Comprehensive Cancer Centre, King’s College London, Guy’s Campus, New Hunt’s House, Room 2.36b, London, SE1 1UL UK
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, B15 2TT UK
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Robert Hills
- Doll Building, CTSU, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF UK
| | - Ian Thomas
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park Way, Cardiff, CF14 4YS UK
| | - Mhairi Copland
- Paul O’Gorman Research Centre, Gartnavel General Hospital, Glasgow, G12 0YN UK
| | - Sue Bell
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | | | - Robert Jones
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Matthew R. Sydes
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
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Selimagic A, Dozic A, Husic-Selimovic A, Tucakovic N, Cehajic A, Subo A, Spahic A, Vanis N. The Role of Inflammation in Anal Cancer. Diseases 2022; 10:27. [PMID: 35645248 PMCID: PMC9149845 DOI: 10.3390/diseases10020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this article was to present a summary of the current resources available in the literature regarding the role of inflammation in anal cancer development. Anal cancer is relatively uncommon, accounting for about 2.7% of all reported gastrointestinal cancers in the United States. However, the importance of understanding the pathogenesis and risk factors for anal cancer has been recognized over the last several decades due to a noticed increase in incidence worldwide. Infections, autoimmune diseases, and inflammatory diseases of unknown etiology cause chronic inflammation that promotes tumorigenesis. The association between chronic inflammation and cancer development is widely accepted. It is based on different pathophysiological mechanisms that lead to cellular transformation and changes in immunological response, allowing tumor cells to avoid apoptosis and immune surveillance. However, there are still many molecular and cellular mechanisms that remain largely unexplored. Further studies on this topic could be of tremendous significance in elucidating anal cancer pathogenesis and developing immunotherapeutic approaches for its treatment.
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Affiliation(s)
- Amir Selimagic
- Department of Gastroenterohepatology, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.H.-S.); (N.T.); (A.C.)
| | - Ada Dozic
- Department of Internal Medicine, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.D.); (A.S.); (A.S.); (N.V.)
| | - Azra Husic-Selimovic
- Department of Gastroenterohepatology, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.H.-S.); (N.T.); (A.C.)
| | - Nijaz Tucakovic
- Department of Gastroenterohepatology, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.H.-S.); (N.T.); (A.C.)
| | - Amir Cehajic
- Department of Gastroenterohepatology, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.H.-S.); (N.T.); (A.C.)
| | - Anela Subo
- Department of Internal Medicine, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.D.); (A.S.); (A.S.); (N.V.)
| | - Azra Spahic
- Department of Internal Medicine, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.D.); (A.S.); (A.S.); (N.V.)
| | - Nedim Vanis
- Department of Internal Medicine, General Hospital “Prim. dr. Abdulah Nakas”, 71 000 Sarajevo, Bosnia and Herzegovina; (A.D.); (A.S.); (A.S.); (N.V.)
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Impact of Definitive Chemoradiation on Quality-of-Life Changes for Patients With Anal Cancer: Long-term Results of a Prospective Study. Dis Colon Rectum 2022; 65:642-653. [PMID: 35067501 DOI: 10.1097/dcr.0000000000002385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Maintaining and improving quality of life (QOL) are important goals of anal cancer management. This disease is generally curable, with many long-term survivors. OBJECTIVE Long-term QOL after chemoradiation for patients with anal cancer was evaluated. DESIGN This was a prospective cohort study. SETTINGS This study used data from a prospective study of patients with anal cancer who were treated with chemoradiation between 2008 and 2013. PATIENTS Patients with anal cancer who were treated with image-guided intensity-modulated radiation therapy were included. INTERVENTIONS English-speaking patients completed European Organization for Research and Treatment of Cancer cancer-specific (C30) and site-specific (CR29) QOL questionnaires at baseline, at end of radiation, at 3 and 6 months, and then annually. MAIN OUTCOMES MEASURES Long-term QOL was evaluated clinically (a change in score of ≥10 points was considered clinically significant) and statistically (using repeated-measurement analysis) by comparing the subscale scores at 1, 2, and 3 years with baseline scores. Subanalysis compared patients who received a radiation dose of 45 to 54 Gy versus 63 Gy. RESULTS Ninety-six patients were included (median follow-up of 56.5 months). The symptom and functional scales showed a clinically significant decline at the end of treatment with improvement by 3 months after treatment. There was a long-term statistically significant decline in dyspnea, body image, bowel embarrassment, fecal incontinence, and hair loss, and there was long-term statistically and clinically significant worsening of impotence. Higher radiation dose (63 Gy) was not associated with significantly worse QOL. LIMITATIONS Limitations included single-institution, single-arm study design, and lack of dose reconstruction (ie, analyses were based on prescribed, rather than delivered, dose). CONCLUSIONS Patients with anal cancer treated with chemoradiation reported recovery of overall QOL to baseline levels. Specific symptoms remained bothersome, emphasizing the need to address and manage the chemoradiation-induced symptoms, during treatment and in the long term. See Video Abstract at http://links.lww.com/DCR/B905. IMPACTO DE LA QUIMIORRADIACIN DEFINITIVA EN CAMBIOS EN LA CALIDAD DE VIDA DE LOS PACIENTES CON CNCER ANAL RESULTADOS A LARGO PLAZO DE UN ESTUDIO PROSPECTIVE ANTECEDENTES:Mantener y mejorar la calidad de vida son objetivos importantes del tratamiento del cáncer anal, ya que esta enfermedad generalmente es curable, con muchos sobrevivientes a largo plazo.OBJETIVO:Se evaluó la calidad de vida a largo plazo después de la quimiorradiación en pacientes con cáncer anal.DISEÑO:Este fue un estudio de cohorte prospectivo.ENTORNO CLINICO:Utilizamos datos de un estudio prospectivo en pacientes con cáncer anal tratados con quimiorradiación entre 2008-2013.PACIENTES:Los pacientes con cáncer anal fueron tratados con radioterapia de intensidad modulada guiada por imágenes.INTERVENCIONES:Los pacientes de habla inglesa completaron los cuestionarios de calidad de vida específicos de cáncer (C30) y específicos del sitio (CR29) de la Organización Europea para la Investigación y el Tratamiento del Cáncer al inicio, al final de la radiación, 3 y 6 meses, y luego anualmente.PRINCIPALES MEDIDAS DE RESULTADOS:Se evaluó a largo plazo la calidad de vida clínicamente (un cambio en la puntuación de ≥10 puntos se consideraron clínicamente significativo) y estadísticamente (usando análisis de medición repetida) comparando las subescalas de puntuación al 1, 2, y 3 años. Con puntuaciones de referencia. El subanálisis comparó pacientes que recibieron 45-54 Gy versus 63 Gy.RESULTADOS:Se incluyeron un total de 96 pacientes (mediana de seguimiento: 56,5 meses). La mayoría de las escalas funcionales y de síntomas mostraron una disminución clínicamente significativa al final del tratamiento con una mejoría a los 3 meses posteriores al tratamiento. Hubo una disminución estadísticamente significativa a largo plazo en disnea, imagen corporal, vergüenza intestinal, incontinencia fecal y pérdida de cabello; y hubo un empeoramiento a largo plazo estadística y clínicamente significativo en impotencia. La dosis de radiación más alta (63 Gy) no se asoció con una calidad de vida significativamente peor.LIMITACIONES:Institución única, diseño de estudio de un solo brazo y falta de recomposición de la dosis (es decir, los análisis se basan en la dosis prescrita, en lugar de la administrada).CONCLUSIÓNES:Los pacientes con cáncer anal tratados con quimiorradiación reportaron una recuperación de la QOL en general a los niveles de base. Síntomas específicos siguieron siendo molestos, lo que enfatiza la necesidad de resolver y tartar los síntomas inducidos por la quimiorradiación no solo durante el tratamiento, sino a largo plazo. Consulte Video Resumen en http://links.lww.com/DCR/B905. (Traducción- Dr. Francisco M. Abarca-Rendon).
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Barroso LF, Stier EA, Hillman R, Palefsky J. Anal Cancer Screening and Prevention: Summary of Evidence Reviewed for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infection Guidelines. Clin Infect Dis 2022; 74:S179-S192. [PMID: 35416975 DOI: 10.1093/cid/ciac044] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In June 2019 the Centers for Disease Control and Prevention (CDC) convened an advisory group to assist in development of the 2021 CDC sexually transmitted infections (STI) guidelines. The advisory group on anal cancer screening and prevention met to formulate key questions in this field. The group examined published literature and abstracts to assess evidence and give recommendations for development of the CDC guidelines. This article summarizes key questions, evidence, recommendations, and areas for further research for the screening, diagnosis, and prevention of anal cancer.
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Affiliation(s)
- Luis F Barroso
- Internal Medicine/Infectious Diseases, Wake Forest University Health Sciences, Winston-Salem, North CarolinaUSA
| | - Elizabeth A Stier
- Obstetrics and Gynecology, Boston University School of Medicine, Boston Medical Center, Boston, MassachusettsUSA
| | - Richard Hillman
- Dysplasia and Anal Cancer Services, St Vincent's Hospital, Darlinghurst, Sydney, Australia
| | - Joel Palefsky
- Infectious Diseases, University of California, San Francisco, CaliforniaUSA
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Franco P, Segelov E, Johnsson A, Riechelmann R, Guren MG, Das P, Rao S, Arnold D, Spindler KLG, Deutsch E, Krengli M, Tombolini V, Sebag-Montefiore D, De Felice F. A Machine-Learning-Based Bibliometric Analysis of the Scientific Literature on Anal Cancer. Cancers (Basel) 2022; 14:cancers14071697. [PMID: 35406469 PMCID: PMC8996998 DOI: 10.3390/cancers14071697] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/26/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Squamous-cell carcinoma of the anus, being a rare cancer, requires national and international collaborations, networking, organizational proficiency and leadership to overcome barriers towards the implementation of clinical trials to establish improved standards of care treatment strategies and the conduction of translational research projects to shed light into its biology and molecular characterization. The purpose of the present study is to obtain a global frame of the scientific literature related to anal cancer, through a bibliometric analysis of the published articles during the last 20 years (2000–2020), exploring trends and common patterns in research, tracking collaboration and networks to foresee future directions in basic and clinical research. Abstract Squamous-cell carcinoma of the anus (ASCC) is a rare disease. Barriers have been encountered to conduct clinical and translational research in this setting. Despite this, ASCC has been a prime example of collaboration amongst researchers. We performed a bibliometric analysis of ASCC-related literature of the last 20 years, exploring common patterns in research, tracking collaboration and identifying gaps. The electronic Scopus database was searched using the keywords “anal cancer”, to include manuscripts published in English, between 2000 and 2020. Data analysis was performed using R-Studio 0.98.1091 software. A machine-learning bibliometric method was applied. The bibliometrix R package was used. A total of 2322 scientific documents was found. The average annual growth rate in publication was around 40% during 2000–2020. The five most productive countries were United States of America (USA), United Kingdom (UK), France, Italy and Australia. The USA and UK had the greatest link strength of international collaboration (22.6% and 19.0%). Two main clusters of keywords for published research were identified: (a) prevention and screening and (b) overall management. Emerging topics included imaging, biomarkers and patient-reported outcomes. Further efforts are required to increase collaboration and funding to sustain future research in the setting of ASCC.
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Affiliation(s)
- Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, 28100 Novara, Italy;
- Department of Radiation Oncology, “Maggiore della Carità” University Hospital, 28100 Novara, Italy
- Correspondence: ; Tel.: +39-0321-3733424; Fax: +39-0321-3733698
| | - Eva Segelov
- School of Clinical Sciences, Faculty of Medicine, Monash University, Clayton 3168, Australia;
- Department of Oncology, Monash Health, Clayton 3168, Australia
| | - Anders Johnsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, 22002 Lund, Sweden;
| | - Rachel Riechelmann
- Department of Clinical Oncology, AC Camargo Cancer Center, São Paulo 01000-000, Brazil;
| | - Marianne G. Guren
- Department of Oncology, Oslo University Hospital, 0316 Oslo, Norway;
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Sheela Rao
- GI Unit, Royal Marsden Hospital, London SW3 6JJ, UK;
| | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg, AK Altona, 22763 Hamburg, Germany;
| | | | - Eric Deutsch
- Institute Gustave Roussy, 94805 Villejuif, France;
| | - Marco Krengli
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, 28100 Novara, Italy;
- Department of Radiation Oncology, “Maggiore della Carità” University Hospital, 28100 Novara, Italy
| | - Vincenzo Tombolini
- Radiation Oncology, Policlinico “Umberto I” and Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.T.); (F.D.F.)
| | | | - Francesca De Felice
- Radiation Oncology, Policlinico “Umberto I” and Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.T.); (F.D.F.)
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12
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Incidence, Persistence, and Clearance of Anal Human Papillomavirus among Men Who Have Sex with Men in China: An Observational Cohort Study. Pathogens 2022; 11:pathogens11030314. [PMID: 35335637 PMCID: PMC8949987 DOI: 10.3390/pathogens11030314] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 02/07/2023] Open
Abstract
(1) Background: We conducted a prospective observational cohort study to measure incidence, persistence, and clearance of anal human papillomavirus (HPV) among men who have sex with men (MSM) in China. (2) Methods: MSM were recruited in Guangzhou, Shenzhen and Wuxi, China in 2017. A tablet-based questionnaire was used to collect sociodemographic and behavioral characteristics. An anal brush sample was collected for HPV testing and genotyping. Participants were followed up 12 months after enrolment. (3) Results: A total of 196 participants completed two HPV tests with a median age of 27.3 (interquartile range (IQR) 24.0–32.8) years. Rate of incidence, persistence, and clearance for HPV among MSM were 31.3 (95% confidence interval (CI) 24.7–39.2), 47.9 (36.8–61.3), and 122.5 (104.3–143.0) per 1000 person months (pm), respectively. HPV 16 (4.1/1000 pm) had the highest incidence rate, and HPV 6 (47.4/1000 pm) had the highest persistence rate. Having lower education and engaging in receptive anal intercourse were potential risk factors of HPV incidence. A higher incidence rate was observed among younger MSM. (4) Conclusions: The high incidence and low clearance of anal HPV highlight the necessity of HPV vaccination among MSM. Further studies are needed to clarify the HPV dynamics at multiple anatomical sites and the burden of HPV-related diseases among MSM.
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Silvera R, Martinson T, Gaisa MM, Liu Y, Deshmukh AA, Sigel K. The other side of screening: predictors of treatment and follow-up for anal precancers in a large health system. AIDS 2021; 35:2157-2162. [PMID: 34014851 PMCID: PMC8808754 DOI: 10.1097/qad.0000000000002948] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anal cancer disproportionately affects people with HIV (PWH). High-grade squamous intraepithelial lesions (HSIL) are cancer precursors and treating them might prevent anal cancer. Data on adherence to HSIL treatment and surveillance is limited but needed to identify deficiencies of screening strategies. METHODS We collected data on high-resolution anoscopy (HRA) attendance and outcomes from 2009 to 2019 in a large urban anal cancer-screening program. Patients with an initial HSIL diagnosis were followed for return for HSIL electrocautery ablation within 6 months of index HSIL diagnosis, and follow-up HRA within 18 months of index HSIL diagnosis. We also evaluated predictors of these outcomes in univariable and multivariable analyses. RESULTS One thousand one hundred and seventy-nine unique patients with an anal HSIL diagnosis were identified and 684 (58%) returned for electrocautery ablation. Of those treated, only 174 (25%) and only 9% of untreated HSIL patients (47 of 495) underwent surveillance HRA within 18 months of index HSIL diagnosis. In multivariable analyses, black patients and PWH regardless of virologic control were less likely to undergo HSIL ablation within 6 months of HSIL diagnosis whereas patients with commercial insurance were more likely to be treated within 6 months of diagnosis. Among treated HSIL patients, PWH with viremia had a lower likelihood of engaging in post-treatment surveillance within 18 months of HSIL diagnosis. DISCUSSION Even in large specialized anal cancer screening programs adherence to HSIL treatment and surveillance is low. Psychosocial and economic determinants of health may impact retention in care. Addressing both personal and structural barriers to patient engagement may improve the effectiveness of anal cancer screening.
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Affiliation(s)
- Richard Silvera
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tyler Martinson
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael M. Gaisa
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashish A. Deshmukh
- Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX, USA
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, and
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Guren MG, Sebag-Montefiore D, Franco P, Johnsson A, Segelov E, Deutsch E, Rao S, Spindler KLG, Arnold D. Treatment of Squamous Cell Carcinoma of the Anus, Unresolved Areas and Future Perspectives for Research: Perspectives of Research Needs in Anal Cancer. Clin Colorectal Cancer 2021; 20:279-287. [PMID: 34645589 DOI: 10.1016/j.clcc.2021.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/30/2021] [Accepted: 09/09/2021] [Indexed: 01/12/2023]
Abstract
Anal cancer is a relatively rare, mostly HPV-related cancer. The curative treatment consists of concurrent chemoradiation delivered with modern radiotherapy techniques. The prognosis for most patients with early localized disease is very favourable; however patients with locally advanced disease and/or HPV negative tumours are at higher risk of locoregional and distant treatment failure. Tailored approaches are presently being investigated to determine the most suitable regimen in terms of radiotherapy dose prescription, target volume selection, normal tissue avoidance, and combination therapy. Metastatic anal cancer is treated with chemotherapy aiming at prolonged survival. The role of immune therapy in the clinical setting is being investigated. There is little knowledge on the biology of anal cancer, and an urgent need for more clinical and translational research dedicated to this disease. In this article, the evidence-base for the current treatment is briefly reviewed, and perspectives on future research needs are high-lighted.
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Affiliation(s)
| | | | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont and Department of Radiation Oncology, AOU ''Maggiore della Carità,'' Novara, Italy
| | - Anders Johnsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Eva Segelov
- School of Clinical Sciences, Faculty of Medicine, Monash University, Clayton, Australia and Department of Oncology, Monash Health Clayton, Australia
| | | | - Sheela Rao
- GI Unit, Royal Marsden Hospital, London, UK
| | | | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg, Germany
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15
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Al Bitar S, Ballouz T, Doughan S, Gali-Muhtasib H, Rizk N. Potential role of micro ribonucleic acids in screening for anal cancer in human papilloma virus and human immunodeficiency virus related malignancies. World J Gastrointest Pathophysiol 2021; 12:59-83. [PMID: 34354849 PMCID: PMC8316837 DOI: 10.4291/wjgp.v12.i4.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/24/2021] [Accepted: 05/19/2021] [Indexed: 02/06/2023] Open
Abstract
Despite advances in antiretroviral treatment (ART), human immunodeficiency virus (HIV) continues to be a major global public health issue owing to the increased mortality rates related to the prevalent oncogenic viruses among people living with HIV (PLWH). Human papillomavirus (HPV) is the most common sexually transmitted viral disease in both men and women worldwide. High-risk or oncogenic HPV types are associated with the development of HPV-related malignancies, including cervical, penile, and anal cancer, in addition to oral cancers. The incidence of anal squamous cell cancers is increasing among PLWH, necessitating the need for reliable screening methods in this population at risk. In fact, the currently used screening methods, including the Pap smear, are invasive and are neither sensitive nor specific. Investigators are interested in circulatory and tissue micro ribonucleic acids (miRNAs), as these small non-coding RNAs are ideal biomarkers for early detection and prognosis of cancer. Multiple miRNAs are deregulated during HIV and HPV infection and their deregulation contributes to the pathogenesis of disease. Here, we will review the molecular basis of HIV and HPV co-infections and focus on the pathogenesis and epidemiology of anal cancer in PLWH. The limitations of screening for anal cancer and the need for a reliable screening program that involves specific miRNAs with diagnostic and therapeutic values is also discussed.
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Affiliation(s)
- Samar Al Bitar
- Department of Biology, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Tala Ballouz
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Samer Doughan
- Department of Surgery, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Hala Gali-Muhtasib
- Department of Biology and Center for Drug Discovery, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Nesrine Rizk
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
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17
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Factors associated with anal cancer screening uptake in men who have sex with men living with HIV: a cross-sectional study. Eur J Cancer Prev 2021; 29:1-6. [PMID: 31283539 DOI: 10.1097/cej.0000000000000507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Most western countries have guidelines on anal cancer screening for men who have sex with men (MSM) living with HIV. However, adherence to these guidelines has been studied poorly. This cross-sectional study reports anal cancer screening uptake and identifies the factors associated with a previous screening in MSM living with HIV in a Paris Hospital (France). A total of 410 outpatients completed a self-administered questionnaire on anal cancer screening. The median age was 50 years and the median time from HIV diagnosis was 14.2 years. Overall, 82.2% of patients were aware of anal cancer screening and, of these, 56.7% had already undergone a screening test. The absence of history of screening (43.3%) was most often explained by lack of time (31.3%) or information (28.2%). Among patients familiar with the anal screening procedure, those older than 50 years (adjusted odds ratio=2.4, 95% confidence interval=1.3-4.7, P=0.007) and informed by healthcare providers (adjusted odds ratio=8.2, 95% confidence interval=2.5-32.0, P=0.001) were more likely to have already been screened. To date, adherence to anal cancer screening in MSM living with HIV appears to be inadequate to enable diagnosis of cancer at its early stages. Encouraging physicians to inform MSM living with HIV about anal cancer screening, irrespective of their age, could be an effective strategy to improve anal cancer screening uptake.
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Wakeham K, Murray L, Muirhead R, Hawkins MA, Sebag-Montefiore D, Brown S, Murphy L, Thomas G, Bell S, Whibley M, Morgan C, Sleigh K, Gilbert DC. Multicentre Investigation of Prognostic Factors Incorporating p16 and Tumour Infiltrating Lymphocytes for Anal Cancer After Chemoradiotherapy. Clin Oncol (R Coll Radiol) 2021; 33:638-649. [PMID: 34024700 DOI: 10.1016/j.clon.2021.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022]
Abstract
AIMS Anal squamous cell carcinomas (ASCC) are strongly associated with human papillomaviruses. Standard of care is chemoradiotherapy at uniform doses with no treatment stratification. Immunohistochemical staining for p16INK4A (p16), a surrogate for human papillomaviruses, is prognostic for outcomes. We investigated this alongside clinical-pathological factors, including tumour infiltrating lymphocyte (TIL) scores. MATERIALS AND METHODS Using an independent, multicentre cohort of 257 ASCC treated with chemoradiotherapy, pretreatment biopsies were stained and scored for p16 and TIL. Kaplan-Meier curves were derived for outcomes (disease-free survival [DFS], overall survival and cancer-specific survival), by stage, p16 and TIL scores and Log-rank tests were carried out to investigate prognostic effect. A multivariate analysis was carried out using Cox regression. RESULTS Stage, sex, p16 and TILs were independently prognostic. Hazard ratios for death (overall survival) were 2.51 (95% confidence interval 1.36-4.63) for p16 negative versus p16 positive, 2.17 (1.34-3.5) for T3/4 versus T1/2, 2.42 (1.52-3.8) for males versus females and 3.30 (1.52-7.14) for TIL1 versus TIL3 (all P < 0.05). CONCLUSIONS We have refined prognostic factors in ASCC. p16 adds to stratification by stage with respect to DFS in early disease and overall survival/DFS in locally advanced cancers. Our data support the role of the host immune response in mediating outcomes. These factors will be prospectively evaluated in PLATO (ISRCTN88455282).
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Affiliation(s)
- K Wakeham
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - L Murray
- Leeds Institute of Medical Research, University of Leeds, Leeds Cancer Centre, Leeds, UK
| | - R Muirhead
- Oxford University Hospitals NHS Trust, Department of Oncology, Churchill Hospital, Oxford, UK
| | - M A Hawkins
- University College London, Medical Physics and Biomedical Engineering, London, UK
| | - D Sebag-Montefiore
- Leeds Institute of Medical Research, University of Leeds, Leeds Cancer Centre, Leeds, UK
| | - S Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - L Murphy
- MRC Clinical Trials Unit at UCL, London, UK
| | - G Thomas
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - S Bell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - M Whibley
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - C Morgan
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - K Sleigh
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - D C Gilbert
- MRC Clinical Trials Unit at UCL, London, UK.
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Houlihan OA, Monaghan O, O'Sullivan S, Nugent K, Dunne M, Neary P, Cahill R, Mehigan B, McNamara DA, Salib O, Gillham C, McVey G, Faul C, Cunningham M, Armstrong J, O'Neill BDP. Anal squamous cell carcinoma: a retrospective case series. Ir J Med Sci 2021; 191:681-686. [PMID: 33977391 DOI: 10.1007/s11845-021-02643-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anal cancer is a relatively rare cancer with 660 cases diagnosed in 2000-2015 in Ireland (1). The current standard treatment is radical chemoradiotherapy (CRT). The aim of our study was to review the treatment and outcomes of patients with localised anal squamous cell carcinoma (SCC), who received radical treatment in our radiation oncology network between 2008 and 2014 inclusive. METHODS Data were collected retrospectively from ARIA® oncology information system and patient charts. Statistical analyses were performed using IBM® SPSS® statistical software version 25.0. RESULTS Seventy-nine cases of anal SCC were identified. Mean age of patients at commencement of radiotherapy (RT) was 60.2 years (standard deviation: 13.1 years). The most common total RT dose was 50.4 Gy in 28 fractions (N = 58; 73.4%). Median follow-up was 5.6 years. Two (2.6%) patients had persistent disease, seventeen (21.8%) patients developed loco-regional recurrence and nine (11.5%) patients developed solid organ metastases, four of whom had complete treatment response at the primary site. Eight patients underwent salvage anal surgery following completion of RT. Median overall survival was 10.5 years (95% confidence interval (CI) 5.1-15.8 years), median loco-regional relapse-free survival was 10.4 years (95% CI 4.4-16.3 years) and median disease-free survival was 9.3 years (95% CI 6.3-12.2 years). CONCLUSION Our study demonstrates that treatment for anal SCC and outcomes following definitive CRT in Ireland during the study period were comparable to international standards.
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Affiliation(s)
- Orla Anne Houlihan
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin, Ireland.
| | - Orla Monaghan
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Siobhra O'Sullivan
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Killian Nugent
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Mary Dunne
- Clinical Trials Resource Unit, St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Paul Neary
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
| | - Ronan Cahill
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Brian Mehigan
- Department of Surgery, St James's Hospital, Dublin 8, Ireland
| | | | - Osama Salib
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Charles Gillham
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Gerard McVey
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Clare Faul
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Moya Cunningham
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin, Ireland
| | - John Armstrong
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin, Ireland
| | - Brian D P O'Neill
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, Dublin, Ireland
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Werner RN, Gaskins M, Avila Valle G, Budach V, Koswig S, Mosthaf FA, Raab HR, Rödel C, Nast A, Siegel R, Aigner F. State of the art treatment for stage I to III anal squamous cell carcinoma: A systematic review and meta-analysis. Radiother Oncol 2021; 157:188-196. [DOI: 10.1016/j.radonc.2021.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/21/2022]
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21
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Dee EC, Byrne JD, Wo JY. Evolution of the Role of Radiotherapy for Anal Cancer. Cancers (Basel) 2021; 13:1208. [PMID: 33801992 PMCID: PMC8001637 DOI: 10.3390/cancers13061208] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 12/11/2022] Open
Abstract
Prior to the 1980s, the primary management of localized anal cancer was surgical resection. Dr. Norman Nigro and colleagues introduced neoadjuvant chemoradiotherapy prior to abdominoperineal resection. Chemoradiotherapy 5-fluorouracil and mitomycin C afforded patients complete pathologic response and obviated the need for upfront surgery. More recent studies have attempted to alter or exclude chemotherapy used in the Nigro regimen to mitigate toxicity, often with worse outcomes. Reductions in acute adverse effects have been associated with marked advancements in radiotherapy delivery using intensity-modulated radiation therapy (IMRT) and image-guidance radiation delivery, resulting in increased tolerance to greater radiation doses. Ongoing trials are attempting to improve IMRT-based treatment of locally advanced disease with efforts to increase personalized treatment. Studies are also examining the role of newer treatment modalities such as proton therapy in treating anal cancer. Here we review the evolution of radiotherapy for anal cancer and describe recent advances. We also elaborate on radiotherapy's role in locally persistent or recurrent anal cancer.
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Affiliation(s)
| | - James D. Byrne
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA 02115, USA;
| | - Jennifer Y. Wo
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA;
- Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom St., Boston, MA 02114, USA
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22
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Maccabe TA, Parwaiz I, Longman RJ, Thomas MG, Messenger DE. Outcomes following local excision of early anal squamous cell carcinomas of the anal canal and perianal margin. Colorectal Dis 2021; 23:689-697. [PMID: 33140913 DOI: 10.1111/codi.15424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/14/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022]
Abstract
AIM There is a paucity of data on outcomes from local excision (LE) of early anal squamous cell carcinomas (ASCCs). This study aimed to assess survival outcomes according to tumour location, perianal (PAT) or anal canal (ACT), and to determine factors associated with R1 excision and outcomes according to T-category. METHODS This was a retrospective cohort study of consecutive patients with early ASCC treated by LE from 2007 to 2019. Data were collected on baseline demographics, tumour location, staging, excision histology, adjuvant treatment, site and timing of recurrence. The main outcome measures were R1 resection, locoregional recurrence (LRR), disease-free survival and overall survival. RESULTS Of 367 patients treated for ASCC, 39 (10.6%) patients with complete follow-up data underwent LE: 15 ACTs and 24 PATs. R1 resections were obtained in 27 patients (69.2%) and occurred more frequently in ACTs than PATs (93.3% vs. 54.2%, P = 0.006). Eighteen of 27 patients (66.7%) received adjuvant therapy (chemoradiotherapy [n = 11], radiotherapy alone [n = 7]) for R1 excision or re-excision, following which LRR developed in one of 10 (10.0%) patients in the ACT cohort and one of eight (12.5%) patients in the PAT cohort. There was no difference in 5-year LRR-free survival (82.0% vs. 70.1%, P = 0.252), disease-free survival (58.2% vs. 78.4%, P = 0.200) or overall survival (86.2% vs. 95.7%, P = 0.607) between the ACT and PAT cohorts. CONCLUSIONS LE is a feasible treatment option for early ASCCs of the perianal margin but not the anal canal. Acceptable long-term outcomes can still be achieved with adjuvant therapy in the presence of a positive margin. Larger prospective studies to assess LE as a treatment strategy, such as the ACT3 trial, are warranted.
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Affiliation(s)
- Tom A Maccabe
- Department of Colorectal Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Iram Parwaiz
- Department of Colorectal Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Robert J Longman
- Department of Colorectal Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Michael G Thomas
- Department of Colorectal Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - David E Messenger
- Department of Colorectal Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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23
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Brogden DRL, Khoo CC, Kontovounisios C, Pellino G, Chong I, Tait D, Warren OJ, Bower M, Tekkis P, Mills SC. Anal squamous cell carcinoma in a high HIV prevalence population. Discov Oncol 2021; 12:3. [PMID: 33844706 PMCID: PMC7878215 DOI: 10.1007/s12672-021-00397-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/26/2021] [Indexed: 02/07/2023] Open
Abstract
Anal Squamous Cell Carcinoma (ASCC) is a rare cancer that has a rapidly increasing incidence in areas with highly developed economies. ASCC is strongly associated with HIV and there appears to be increasing numbers of younger male persons living with HIV (PLWH) diagnosed with ASCC. This is a retrospective cohort study of HIV positive and HIV negative patients diagnosed with primary ASCC between January 2000 and January 2020 in a demographic group with high prevalence rates of HIV. One Hundred and seventy six patients were included, and clinical data was retrieved from multiple, prospective databases. A clinical subgroup was identified in this cohort of younger HIV positive males who were more likely to have had a prior diagnosis of Anal Intraepithelial Neoplasia (AIN). Gender and HIV status had no effect on staging or disease-free survival. PLWH were more likely to develop a recurrence (p < 0.000) but had a longer time to recurrence than HIV negative patients, however this was not statistically significant (46.1 months vs. 17.5 months; p = 0.077). Patients known to have a previous diagnosis of AIN were more likely to have earlier staging and local tumour excision. Five-year Disease-Free Survival was associated with tumour size and the absence of nodal or metastatic disease (p < 0.000).
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Affiliation(s)
- Danielle R. L. Brogden
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | | | - Christos Kontovounisios
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania “Luigi Vanvitelli”, Naples, Italy
- Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Irene Chong
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Diana Tait
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Oliver J. Warren
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Mark Bower
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Paris Tekkis
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK
- Imperial College London, London, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Sarah. C. Mills
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK
- Imperial College London, London, UK
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24
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Gouvas N, Gourtsoyianni S, Kalogeridi MA, Sougklakos J, Vini L, Xynos E. Hellenic society of medical oncology (HESMO) guidelines for the management of anal cancer. Updates Surg 2020; 73:7-21. [PMID: 33231836 DOI: 10.1007/s13304-020-00923-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/29/2020] [Indexed: 01/01/2023]
Abstract
Despite considerable improvement in the management of anal cancer, there is a great deal of variation in the outcomes among European countries, and in particular among different hospital centres in Greece and Cyprus. The aim was to elaborate a consensus on the multidisciplinary management of anal cancer, based on European guidelines (European Society of Medical Oncologists-ESMO), considering local special characteristics of our healthcare system. Following discussion and online communication among members of an executive team, a consensus was developed. Guidelines are proposed along with algorithms of diagnosis and treatment. The importance of centralisation, care by a multidisciplinary team (MDT) and adherence to guidelines are emphasised.
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Affiliation(s)
- Nikolaos Gouvas
- Colorectal Surgeon, Nicosia General Hospital, Medical School, Shacolas Educational Centre for Clinical Medicine, University of Cyprus, Palaios Dromos Lefkosias Lemesou No.215/6Aglantzia, 2029, Nicosia, Cyprus.
| | - Sophia Gourtsoyianni
- Abdominal Radiologist, "Aretaieion" Hospital, Faculty of Medicine, University of Athens, Athens, Greece
| | | | - John Sougklakos
- Medical Oncologist, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Louisa Vini
- Clinical Oncologist/Radiotherapist, "Iatriko" Hopsital of Athens, Athens, Greece
| | - Evangelos Xynos
- Colorectal Surgeon, Creta Inter-Clinic Hopsital, Heraklion, Greece
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25
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Werner RN, Gaskins M, Dressler C, Nast A, Schaefer C, Aigner F, Siegel R. Measuring importance of outcomes to patients: a cross-sectional survey for the German anal cancer guideline. J Clin Epidemiol 2020; 129:40-50. [PMID: 32987160 DOI: 10.1016/j.jclinepi.2020.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/04/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to generate evidence on patients' values and preferences to inform the development of the German national Evidence-based Anal Cancer Guideline. STUDY DESIGN AND SETTING We developed a list of health outcomes based on a systematic search. We then asked anal cancer patients and experts of the guideline development group in an online survey to (a) rate the relative importance of the outcomes in different clinical situations using a nine-point, three-category scale, and (b) select seven outcomes they considered most important for decision-making in each situation. RESULTS Participants rated almost half of the outcomes (45%) as critical for decision-making, and more than half (53%) as important. Only two outcomes (2%) were rated as low in importance. Agreement between expert and patient ratings was low to fair, and we found important discrepancies in how the relative importance of the outcomes was perceived. However, the rankings of outcomes were highly correlated. CONCLUSION Determining the relative importance placed by anal cancer patients on outcomes provided useful information for developing guideline recommendations. Our approach may be useful for guideline developers who aim to include the patient perspective. Moreover, our findings may help health professionals caring for anal cancer patients in joint decision-making.
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Affiliation(s)
- Ricardo N Werner
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Venerology and Allergy, Berlin, Germany.
| | - Matthew Gaskins
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Venerology and Allergy, Berlin, Germany
| | - Corinna Dressler
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Venerology and Allergy, Berlin, Germany
| | - Alexander Nast
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Venerology and Allergy, Berlin, Germany
| | - Corinna Schaefer
- German Agency for Quality in Medicine (AEZQ), Department of Evidence Based Medicine and Guidelines, Department of Patient Information, Berlin, Germany
| | - Felix Aigner
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Virchow-Klinikum and Charité Mitte, Berlin, Germany; Department of Surgery, St. John of God Hospital (Krankenhaus der Barmherzigen Brüder) Graz, Graz, Austria
| | - Robert Siegel
- Department of General, Visceral and Oncological Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany; Department of Visceral, Vascular, and Transplantation Surgery, Faculty of Health, Witten/Herdecke University, Witten, Germany
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26
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Carter TJ, Jeyaneethi J, Kumar J, Karteris E, Glynne-Jones R, Hall M. Identification of Cancer-Associated Circulating Cells in Anal Cancer Patients. Cancers (Basel) 2020; 12:cancers12082229. [PMID: 32785154 PMCID: PMC7465059 DOI: 10.3390/cancers12082229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/26/2022] Open
Abstract
Whilst anal cancer accounts for less than 1% of all new cancer cases, incidence rates have increased by up to 70% in the last 30 years with the majority of cases driven by human papilloma virus (HPV) infection. Standard treatment for localised anal cancer is chemoradiotherapy (CRT). Localised progression is the predominant pattern of relapse but well under 50% of cases are salvaged by surgery, predominantly because confirming recurrence within post-radiation change is very challenging. Identifying cancer-associated circulating cells (CCs) in peripheral blood could offer a corroborative method of monitoring treatment efficacy and identifying relapse early. To study this, nucleated cells were isolated from the blood of patients with anal cancer prior to, during, and after CRT and processed through the Amnis® ImageStream®X Mk II Imaging Flow Cytometer, without prior enrichment, using Pan-cytokeratin (PCK), CD45 antibodies and making use of the DNA dye DRAQ5. Analysis was undertaken using IDEAS software to identify those cells that were PCK-positive and DRAQ5-positive as well as CD45-negative; these were designated as CCs. CCs were identified in 7 of 8 patients; range 60-876 cells per mL of blood. This first report of the successful identification of CCs in anal cancer patients raises the possibility that liquid biopsies will find a future role as a prognostic/diagnostic tool in this patient group.
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Affiliation(s)
- Thomas J. Carter
- Mount Vernon Cancer Centre, Middlesex HA6 2RN, UK; (T.J.C.); (R.G.-J.)
| | - Jeyarooban Jeyaneethi
- Department of Life Sciences, Brunel University, London UB83PH, UK; (J.J.); (J.K.); (E.K.)
| | - Juhi Kumar
- Department of Life Sciences, Brunel University, London UB83PH, UK; (J.J.); (J.K.); (E.K.)
| | - Emmanouil Karteris
- Department of Life Sciences, Brunel University, London UB83PH, UK; (J.J.); (J.K.); (E.K.)
| | - Rob Glynne-Jones
- Mount Vernon Cancer Centre, Middlesex HA6 2RN, UK; (T.J.C.); (R.G.-J.)
- Department of Life Sciences, Brunel University, London UB83PH, UK; (J.J.); (J.K.); (E.K.)
| | - Marcia Hall
- Mount Vernon Cancer Centre, Middlesex HA6 2RN, UK; (T.J.C.); (R.G.-J.)
- Department of Life Sciences, Brunel University, London UB83PH, UK; (J.J.); (J.K.); (E.K.)
- Correspondence:
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27
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Cattelan L, Ghazawi FM, Le M, Savin E, Zubarev A, Lagacé F, Sasseville D, Waschke K, Litvinov IV. Investigating epidemiologic trends and the geographic distribution of patients with anal squamous cell carcinoma throughout Canada. Curr Oncol 2020; 27:e294-e306. [PMID: 32669936 PMCID: PMC7339845 DOI: 10.3747/co.27.6061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Anal cancer is a rare disease, constituting 0.5% of new cancer cases in the United States. The most common subtype is squamous cell carcinoma (scc). Studies in several developed nations have reported on an increasing incidence of anal cancer in recent decades, and various risk factors pertaining to the pathogenesis of the disease have been identified, including infection with the human papillomavirus, tobacco use, and immunosuppression. The epidemiology and distribution of anal scc throughout Canada remain poorly understood, however. Methods Using 3 population-based cancer registries, a retrospective analysis of demographic data across Canada for 1992-2010 was performed. The incidence and mortality for anal scc was examined at the levels of provinces, cities, and the forward sortation area (FSA) component (first 3 characters) of postal codes. Results During 1992-2010, 3720 individuals were diagnosed with anal scc in Canada; 64% were women. The overall national incidence rate was 6.3 cases per million population per year, with an average age at diagnosis of 60.4 years. The incidence increased over time, with significantly higher incidence rates documented in British Columbia and Nova Scotia (9.3 cases per million population each). Closer examination revealed clustering of cases in various urban centres and self-identified lgbtq communities in Toronto, Montreal, and Vancouver. Discussion This study provides, for the first time, a comprehensive analysis of the burden of anal scc in Canada, identifying susceptible populations and shedding light onto novel avenues of research to lower the incidence of anal cancer throughout the country.
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Affiliation(s)
- L Cattelan
- Department of Medicine, McGill University, Montreal, QC
| | - F M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, ON
| | - M Le
- Division of Dermatology, McGill University, Montreal, QC
| | - E Savin
- Division of Dermatology, McGill University, Montreal, QC
| | - A Zubarev
- Division of Dermatology, McGill University, Montreal, QC
| | - F Lagacé
- Department of Medicine, McGill University, Montreal, QC
| | - D Sasseville
- Division of Dermatology, McGill University, Montreal, QC
| | - K Waschke
- Division of Gastroenterology, McGill University, Montreal, QC
| | - I V Litvinov
- Division of Dermatology, McGill University, Montreal, QC
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28
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Grabovac I, Smith L, Yang L, Soysal P, Veronese N, Turan Isik A, Forwood S, Jackson S. The relationship between chronic diseases and number of sexual partners: an exploratory analysis. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:100-107. [PMID: 32054661 DOI: 10.1136/bmjsrh-2019-200352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 12/08/2019] [Accepted: 12/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND We investigated sex-specific associations between lifetime number of sexual partners and several health outcomes in a large sample of older adults in England. METHODS We used cross-sectional data from 2537 men and 3185 women aged ≥50 years participating in the English Longitudinal Study of Ageing. Participants reported the number of sexual partners they had had in their lifetime. Outcomes were self-rated health and self-reported limiting long-standing illness, cancer, coronary heart disease, and stroke. We used logistic regression to analyse associations between lifetime number of sexual partners and health outcomes, adjusted for relevant sociodemographic and health-related covariates. RESULTS Having had 10 or more lifetime sexual partners was associated with higher odds of reporting a diagnosis of cancer than having had 0-1 sexual partners in men (OR 1.69, 95% CI 1.01 to 2.83) and women (OR 1.91, 95% CI 1.04 to 3.51), respectively. Women who had 10 or more lifetime sexual partners also had higher odds of reporting a limiting long-standing illness (OR 1.64, 95% CI 1.15 to 2.35). No other statistically significant associations were observed. CONCLUSIONS A higher lifetime number of sexual partners is associated with increased odds of reported cancer. Longitudinal research is required to establish causality. Understanding the predictive value of lifetime number of sexual partners as a behavioural risk factor may improve clinical assessment of cancer risk in older adults.
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Affiliation(s)
- Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University Vienna, Vienna, Austria
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Lin Yang
- Alberta Health Services, Calgary, Alberta, Canada
| | - Pinar Soysal
- Department of Geriatric Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Nicola Veronese
- Neuroscience Institute, Aging Branch, National Research Council, Padua, Italy
| | - Ahmet Turan Isik
- Department of Geriatric Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Suzanna Forwood
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Sarah Jackson
- Department of Behavioural Science and Health, University College London, London, UK
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Anal human papillomavirus and its associations with abnormal anal cytology among men who have sex with men. Sci Rep 2020; 10:3165. [PMID: 32081941 PMCID: PMC7035349 DOI: 10.1038/s41598-020-59967-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/28/2020] [Indexed: 12/12/2022] Open
Abstract
Human papillomavirus (HPV) infection contributes to most anal cancers and premalignant intraepithelial lesions. This study investigated anal HPV infections and cytological abnormalities among men who have sex with men (MSM). Sociodemographic characteristics and sexual behaviors were collected by using a structured questionnaire. Anal cytological results were examined, and HPV genotyping was performed by the Linear Array HPV Genotyping test. Logistic regression was used to estimate risk factors and their associations with high-risk HPV infection and cytological abnormalities. Among 163 MSM, 101 were seropositive for human immunodeficiency virus (HIV) and 62 were seronegative for HIV. The overall prevalence of HPV was 66.2%. A total of 61.9% and 48.2% of participants had never acquired any of either the quadrivalent or nonavalent vaccine HPV types, respectively. Cytological findings showed 15.3% atypical squamous cells of undetermined significance, 16.6% low-grade squamous intraepithelial lesion, 4.9% atypical squamous cells that cannot exclude high-grade squamous intraepithelial lesion and 17% high-grade squamous intraepithelial lesion. The number of high-risk HPV types was the predominant risk factor for abnormal anal cytology (OR 2.02, 95% CI 1.27–3.24). Infection with high-risk HPV was a significant predictor for cytological abnormality. MSM should be encouraged to obtain the HPV vaccine.
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30
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Shakir R, Adams R, Cooper R, Downing A, Geh I, Gilbert D, Jacobs C, Jones C, Lorimer C, Namelo WC, Sebag-Montefiore D, Shaw P, Muirhead R. Patterns and Predictors of Relapse Following Radical Chemoradiation Therapy Delivered Using Intensity Modulated Radiation Therapy With a Simultaneous Integrated Boost in Anal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2020; 106:329-339. [PMID: 31629837 PMCID: PMC6961207 DOI: 10.1016/j.ijrobp.2019.10.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Our purpose was to describe the patterns and predictors of treatment failure in patients receiving definitive chemoradiation therapy (CRT) for anal squamous cell carcinoma (ASCC), delivered using intensity modulated radiation therapy (IMRT). METHODS AND MATERIALS Our study was a retrospective cohort analysis of consecutive patients treated with curative intent for ASCC using CRT delivered with a standardized IMRT technique in 5 UK cancer centers. Patients were included from the start of UK IMRT guidance from February 2013 to October 31, 2017. Collected data included baseline demographics, treatment details, tumor control, sites of relapse, and overall survival. Statistical analysis to calculate outcomes and predictive factors for outcome measures were performed using SPSS and R. RESULTS The medical records of 385 consecutive patients were analyzed. Median follow-up was 24.0 months. Within 6 months of completing CRT, 86.7% of patients achieved a complete response. Three-year disease-free survival and overall survival were 75.6% and 85.6%, respectively. Of all relapses, 83.4% occurred at the site of primary disease. There were 2 isolated relapses in regional nodes not involved at outset. Predictive factors for cancer recurrence included male sex, high N-stage, and failure to complete radiation therapy as planned. CONCLUSIONS The treatment results compare favorably to published outcomes from similar cohorts using 3-dimensional conformal CRT. The observed patterns of failure support the current UK IMRT voluming guidelines and dose levels, highlighting our prophylactic nodal dose as sufficient to prevent isolated regional relapse in uninvolved nodes. Further investigation of strategies to optimize CR should remain a priority in ASCC because the site of primary disease remains the overwhelming site of relapse.
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Affiliation(s)
- Rebecca Shakir
- Oxford Cancer and Haematology Centre, Oxford University Hospitals, Oxford, United Kingdom; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Rachel Cooper
- Radiotherapy Research Group, Leeds Cancer Centre, St James's University Hospital, Leeds, United Kingdom
| | - Amy Downing
- Leeds Institute for Medical Research at St James, University of Leeds, United Kingdom
| | - Ian Geh
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Duncan Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Clare Jacobs
- Oxford Cancer and Haematology Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Christopher Jones
- Radiotherapy Research Group, Leeds Cancer Centre, St James's University Hospital, Leeds, United Kingdom; School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Cressida Lorimer
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | | | - David Sebag-Montefiore
- Radiotherapy Research Group, Leeds Cancer Centre, St James's University Hospital, Leeds, United Kingdom; Leeds Clinical Trials Unit, Faculty of Medicine & Health, University of Leeds, United Kingdom
| | - Paul Shaw
- Velindre Cancer Centre, Cardiff, United Kingdom; School of Biosciences, Cardiff University, United Kingdom
| | - Rebecca Muirhead
- Oxford Cancer and Haematology Centre, Oxford University Hospitals, Oxford, United Kingdom.
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Brown PJ, Zhong J, Frood R, Currie S, Gilbert A, Appelt AL, Sebag-Montefiore D, Scarsbrook A. Prediction of outcome in anal squamous cell carcinoma using radiomic feature analysis of pre-treatment FDG PET-CT. Eur J Nucl Med Mol Imaging 2019; 46:2790-2799. [PMID: 31482428 PMCID: PMC6879433 DOI: 10.1007/s00259-019-04495-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Incidence of anal squamous cell carcinoma (ASCC) is increasing, with curative chemoradiotherapy (CRT) as the primary treatment of non-metastatic disease. A significant proportion of patients have locoregional treatment failure (LRF), but distant relapse is uncommon. Accurate prognostication of progression-free survival (PFS) would help personalisation of CRT regimens. The study aim was to evaluate novel imaging pre-treatment features, to prognosticate for PFS in ASCC. METHODS Consecutive patients with ASCC treated with curative intent at a large tertiary referral centre who underwent pre-treatment FDG-PET/CT were included. Radiomic feature extraction was performed using LIFEx software on baseline FDG-PET/CT. Outcome data (PFS) was collated from electronic patient records. Elastic net regularisation and feature selection were used for logistic regression model generation on a randomly selected training cohort and applied to a validation cohort using TRIPOD guidelines. ROC-AUC analysis was used to compare performance of a regression model encompassing standard clinical prognostic factors (age, sex, tumour and nodal stage-model A), a radiomic feature model (model B) and a combined radiomic/clinical model (model C). RESULTS A total of 189 patients were included in the study, with 145 in the training cohort and 44 in the validation cohort. Median follow-up was 35.1 and 37. 9 months, respectively for each cohort, with 70.3% and 68.2% reaching this time-point with PFS. GLCM entropy (a measure of randomness of distribution of co-occurring pixel grey-levels), NGLDM busyness (a measure of spatial frequency of changes in intensity between nearby voxels of different grey-level), minimum CT value (lowest HU within the lesion) and SMTV (a standardized version of MTV) were selected for inclusion in the prognostic model, alongside tumour and nodal stage. AUCs for performance of model A (clinical), B (radiomic) and C (radiomic/clinical) were 0.6355, 0.7403, 0.7412 in the training cohort and 0.6024, 0.6595, 0.7381 in the validation cohort. CONCLUSION Radiomic features extracted from pre-treatment FDG-PET/CT in patients with ASCC may provide better PFS prognosis than conventional staging parameters. With external validation, this might be useful to help personalise CRT regimens in the future.
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Affiliation(s)
- P J Brown
- Department of Clinical Radiology, Lincoln Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
| | - J Zhong
- Department of Clinical Radiology, Lincoln Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - R Frood
- Department of Clinical Radiology, Lincoln Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - S Currie
- Department of Clinical Radiology, Lincoln Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
- Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - A Gilbert
- Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Bexley Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - A L Appelt
- Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Bexley Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - D Sebag-Montefiore
- Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Bexley Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - A Scarsbrook
- Department of Clinical Radiology, Lincoln Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
- Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
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Parwaiz I, MacCabe T, Thomas M, Messenger D. A Systematic Review and Meta-Analysis of Prognostic Biomarkers in Anal Squamous Cell Carcinoma Treated With Primary Chemoradiotherapy. Clin Oncol (R Coll Radiol) 2019; 31:e1-e13. [DOI: 10.1016/j.clon.2019.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/15/2019] [Accepted: 05/21/2019] [Indexed: 01/22/2023]
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Long-term results achieved by guideline-based stage-dependent management of anal cancer in a non-HIV population. Int J Colorectal Dis 2019; 34:1895-1905. [PMID: 31641849 DOI: 10.1007/s00384-019-03396-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Therapy of anal cancer follows national and international guidelines that are mainly derived from randomized trials. This study aimed to analyze long-term results of stage-dependent treatment of anal cancer in a non-selected patient cohort. PATIENTS AND METHOD All consecutive patients treated for anal cancer between 2000 and 2015 were retrieved from a prospective database. Risk-dependent screening for human immunodeficiency virus showed no infection. Main outcome measure was overall survival with respect to tumor site and treatment. Secondary endpoints were cause-specific survival, stoma free survival, and the rate of salvage operations. RESULTS In total, 106 patients were treated for anal cancer. Of those, 69 (65.1%) suffered from anal canal cancer and 37 (34.9%) from anal margin cancer. Three patients with synchronous distant metastases were excluded from analysis. The majority of patients (n = 79, 76.7%) were treated by chemoradiotherapy in curative intention. Twenty-two patients underwent local surgery. Five-year overall survival was 73.1% and cause-specific survival at 5 years was 87.4%. Overall, 14 patients (13.6%) needed salvage surgery. Their 5-year cause-specific survival was 57.7%. A permanent ostomy was avoided in 77.7%. CONCLUSIONS Treatment of anal cancer results in low rates of salvage surgery and permanent ostomies, when therapy was determined by a multidisciplinary team following national and international guidelines.
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Ajala-Agbo T, Tang PT, Bat-Ulzii Davidson T. Unilateral leg weakness and pain secondary to metastatic anal squamous cell carcinoma. BMJ Case Rep 2019; 12:e227563. [PMID: 31308182 PMCID: PMC6663235 DOI: 10.1136/bcr-2018-227563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 11/03/2022] Open
Abstract
A 58-year-old man presented to colorectal clinic with intermittent rectal bleeding, weight loss, also pain and weakness affecting his lower back and right leg. On inspection, there were perianal warts (condyloma acuminata), with an additional palpable anal lesion on digital rectal examination, confirmed by colonoscopy. Subsequent imaging revealed a large right psoas abscess, and an associated paravertebral soft tissue component invading the right lumbosacral plexus and nerve roots at L4, L5 and S1. Biopsy of the paravertebral mass revealed metastatic squamous cell carcinoma. Given his symptomatology, and also as biopsy of the perianal warts revealed high-grade squamous intraepithelial lesion/grade III anal intraepithelial neoplasia on histology with infection by human papillomavirus type 6, the primary was presumed to be anal. This was a case of sciatic pain which proved to be diagnostically challenging on initial presentation to primary care. This mode of presentation and pattern of metastasis are uncommon in anal cancer.
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Affiliation(s)
| | - Pok Tin Tang
- Department of General Surgery, Stoke Mandeville Hospital, Aylesbury, UK
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Renehan AG, Muirhead R, Berkman L, McParland L, Sebag-Montefiore D. Early stage anal margin cancer: towards evidence-based management. Colorectal Dis 2019; 21:387-391. [PMID: 30687991 DOI: 10.1111/codi.14571] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/12/2019] [Indexed: 02/08/2023]
Affiliation(s)
- A G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - R Muirhead
- Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L Berkman
- Patient and Public Involvement Trial Representative, London, UK
| | - L McParland
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - D Sebag-Montefiore
- Leeds Cancer Centre, St James University Hospital, University of Leeds, Leeds, UK
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Rising Incidence and Improved Survival of Anal Squamous Cell Carcinoma in Norway, 1987-2016. Clin Colorectal Cancer 2019; 18:e96-e103. [DOI: 10.1016/j.clcc.2018.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 01/29/2023]
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Díaz Del Arco C, García D, Sanabria C, Rodríguez Escudero E, Domínguez I, Sanz Ortega G, Fernández Aceñero MJ. Anal cytology in women: Experience from a single tertiary center. Pathol Res Pract 2019; 215:905-909. [PMID: 30718099 DOI: 10.1016/j.prp.2019.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/06/2019] [Accepted: 01/25/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Anal cytology (AC) can be used as a screening tool for detection of anal HPV associated lesions, mainly in men who have sex with men and in immunosuppressed patients. Our aim is to review our experience with AC in women. MATERIAL & METHODS We have retrospectively reviewed all AC diagnosed between 2010-2017 in a single tertiary hospital (n = 644) and selected those performed in women (n = 158). RESULTS 24.53% of AC were performed in women. 14.7% of all women were HIV positive and 56.7% referred anal intercourse. Squamous lesions were found in 27.2% of women, most of them ASCUS and LSIL (14% and 11.5%). HPV DNA was detected in 38.6% of patients, and 63.9% of them showed positivity for multiple high-risk types. Anal biopsy showed high grade lesions in 20% of biopsied patients. We observed a significant relationship between HPV status and receptive anal sex, and the association between HPV status and anal histological diagnosis tended to significance. Sensitivity, specificity, negative predictive value and positive predictive value for anal cytology were 57%; 83%; 28% and 94%, respectively. 70.9% of women had synchronous cervical cytology, and squamous cervical lesions were detected in 46.4% of the cases, most of them LSIL or ASCUS (21.4% and 15.2%). We did not confirm a significant association between cytological diagnosis of cervical and anal samples. CONCLUSIONS AC is less widely used in women than in homosexual men. However, women show important rates of anal lesions, regardless of their HIV status. More studies should be performed to assess the potential impact of screening protocols in this population.
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Affiliation(s)
- C Díaz Del Arco
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain; Complutense University of Madrid, Spain.
| | - D García
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain.
| | - C Sanabria
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain.
| | | | - I Domínguez
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain; Department of General and Gastrointestinal Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - G Sanz Ortega
- Department of General and Gastrointestinal Surgery, Hospital Clínico San Carlos, Madrid, Spain.
| | - M J Fernández Aceñero
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain; Complutense University of Madrid, Spain.
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Gleeson I, Rose C, Spurrell J. Dosimetric comparison of helical tomotherapy and VMAT for anal cancer: A single institutional experience. Med Dosim 2019; 44:e32-e38. [PMID: 30639142 DOI: 10.1016/j.meddos.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 11/17/2022]
Abstract
To compare the dosimetric results of helical tomotherapy (HT) and volumetric arc therapy (VMAT) in the treatment of anal cancer. Plans were created for 20 (n = 20) patients treated for anal cancer using HT and 2 arc VMAT. Dosimetric comparison was assessed for doses to targets and organs at risk (small bowel, bladder, external genitalia, and femoral heads). Delivery time and dosimetric verification results were also compared. HT showed a higher V95% for both primary and nodal targets (V95% increase by 0.5% to 1.3%; p = ≤0.05). No differences were seen in V105%, V107%, or V110 % between techniques. HT provided better sparing of the small bowel for dose levels V30, V35, and V40 (p = 0.005, 0.001, and 0.030), but was similar at higher doses. Similarly HT provided better bladder dose at V35 only (p = 0.020). Doses to femoral heads and genitalia were similar. Delivery time was higher for the HT plans (4.58 ± 1.1 min) than VMAT (3.13 ± 0.2 minutes) (p = 0.011). Dose verification results were 99.5 ± 0.9% and 100 ± 0% (HT, n = 6) vs 95.0 ± 3.1% and 99.2 ± 0.8% (VMAT, n = 20) for global gamma criteria 3%/3 mm and 4%/4 mm, respectively. Both HT and VMAT produced high quality plans that frequently met most of the dose objectives apart from genitalia V20, V40, bladder V35, and V50. Although absolute dose differences were small, the PTV V95%, small bowel V30, V35, and V40 and bladder V35 were statistically better in the HT plans. VMAT provided a shorter delivery time by 1.45 minutes; however, our HT plans were more likely to pass tighter plan dose verification criteria than VMAT.
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Affiliation(s)
- Ian Gleeson
- Department of Medical Physics, Addenbrooke's Hospital, Cambridge, CB20QQ, UK.
| | - Christopher Rose
- Department of Medical Physics, Addenbrooke's Hospital, Cambridge, CB20QQ, UK.
| | - Joshua Spurrell
- Department of Medical Physics, Addenbrooke's Hospital, Cambridge, CB20QQ, UK.
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Vuitton L, Jacquin E, Parmentier AL, Crochet E, Fein F, Dupont-Gossart AC, Plastaras L, Bretagne CH, Mauny F, Koch S, Prétet JL, Mougin C, Valmary-Degano S. High Prevalence of Anal Canal High-Risk Human Papillomavirus Infection in Patients With Crohn's Disease. Clin Gastroenterol Hepatol 2018; 16:1768-1776.e5. [PMID: 29551740 DOI: 10.1016/j.cgh.2018.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 02/27/2018] [Accepted: 03/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The increasing incidence of anal canal carcinomas requires better knowledge on anal human papillomavirus (HPV) infection. We aimed to assess anal canal HPV infection prevalence and risk factors among patients seen at a gastroenterology department in France. METHODS We analyzed anal tissue samples collected from 469 consecutive patients (median age 54 years, 52% women), including 112 who received immunosuppressant therapies and 101 with inflammatory bowel disease (70 with Crohn's disease), who underwent colonoscopy examinations from April 1, 2012 to April 30, 2015. HPV was detected and genotyped using the INNO-LiPA assay, and we collected medical and demographic data from all subjects. Risk factors for any HPV, high-risk HPV (HR-HPV) and HPV16 infection were assessed by bivariate and multivariate analysis. The primary outcomes association of HR-HPV or HPV16 with medical and demographic features. RESULTS We detected HPV DNA in anal tissues from 34% of the subjects and HR-HPV in 18%. HPV16 was the most prevalent genotype (detected in 7%), followed by HPV51, HPV52, and HPV39. HR-HPV was detected in a significantly higher proportion of samples from women (23.1%) than men (12.8%) (P = .0035); HR-HPV and HPV16 were detected in a significantly higher proportion of patients with Crohn's disease (30.0%) than without (18.1%) (P = .005). Female sex, history of sexually transmitted disease, lifetime and past year-number of sexual partners, active smoking, and immunosuppressive therapies were independent risk factors for anal HR-HPV infection in multivariate analysis. CONCLUSION One third of patients who underwent colonoscopy at a gastroenterology department were found to have anal canal HPV infection. We detected HR-HPV infection in almost 20% of patients and in a significantly higher proportion of patients with Crohn's disease than without. Increasing our knowledge of HPV infection of anal tissues could help physicians identify populations at risk and promote prophylaxis with vaccination and adequate screening.
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Affiliation(s)
- Lucine Vuitton
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France; EA3181, Université Bourgogne Franche-Comté, LAbEx LipSTIC ANR-11-LABX-0021, National Reference Center, Besançon, France.
| | - Elise Jacquin
- EA3181, Université Bourgogne Franche-Comté, LAbEx LipSTIC ANR-11-LABX-0021, National Reference Center, Besançon, France
| | | | - Elise Crochet
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Francine Fein
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | | | - Laurianne Plastaras
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France; Department of Hepato-gastroenterology, Colmar General Hospital, Colmar, France
| | | | - Frédéric Mauny
- Centre de Méthodologie Clinique, University Hospital of Besançon, Besançon, France
| | - Stéphane Koch
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Jean-Luc Prétet
- EA3181, Université Bourgogne Franche-Comté, LAbEx LipSTIC ANR-11-LABX-0021, National Reference Center, Besançon, France; Department of Pathology, University Hospital of Besançon, Besançon, France
| | - Christiane Mougin
- EA3181, Université Bourgogne Franche-Comté, LAbEx LipSTIC ANR-11-LABX-0021, National Reference Center, Besançon, France; Department of Pathology, University Hospital of Besançon, Besançon, France
| | - Séverine Valmary-Degano
- EA3181, Université Bourgogne Franche-Comté, LAbEx LipSTIC ANR-11-LABX-0021, National Reference Center, Besançon, France; Department of Pathology, University Hospital of Besançon, Besançon, France
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Pan YB, Maeda Y, Wilson A, Glynne-Jones R, Vaizey CJ. Late gastrointestinal toxicity after radiotherapy for anal cancer: a systematic literature review. Acta Oncol 2018; 57:1427-1437. [PMID: 30264638 DOI: 10.1080/0284186x.2018.1503713] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION There is a paucity of data on incidence and mechanisms of long-term gastrointestinal consequences after chemoradiotherapy for anal cancer. Most of the adverse effects reported were based on traditional external beam radiotherapy whilst only short-term follow-ups have been available for intensity-modulated radiotherapy, and there is lack of knowledge about consequences of dose-escalation radiotherapy. METHOD A systematic literature review. RESULTS Two thousand nine hundred and eighty-five titles (excluding duplicates) were identified through the search; 130 articles were included in this review. The overall incidence of late gastrointestinal toxicity was reported to be 7-64.5%, with Grade 3 and above (classified as severe) up to 33.3%. The most commonly reported late toxicities were fecal incontinence (up to 44%), diarrhea (up to 26.7%), and ulceration (up to 22.6%). Diarrhea, fecal incontinence and buttock pain were associated with lower scores in radiotherapy specific quality of life scales (QLQ-CR29, QLQ-C30, and QLQ-CR38) compared to healthy controls. Intensity-modulated radiation therapy appears to reduce late toxicity. CONCLUSION Late gastrointestinal toxicities are common with severe toxicity seen in one-third of the patients. These symptoms significantly impact on patients' quality of life. Prospective studies with control groups are needed to elucidate long-term toxicity.
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Affiliation(s)
- Yi Bin Pan
- Sir Alan Parks Physiology Unit, St. Mark’s Hospital, Harrow, UK
- Longhua Hospital, Shanghai University of TCM, Shanghai, China
| | - Yasuko Maeda
- Sir Alan Parks Physiology Unit, St. Mark’s Hospital, Harrow, UK
- Imperial College London, London, UK
| | - Ana Wilson
- Imperial College London, London, UK
- Wolfson Unit of Endoscopy, St. Mark’s Hospital, Harrow, UK
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Prue G, Grimes D, Baker P, Lawler M. Access to HPV vaccination for boys in the United Kingdom. MEDICINE ACCESS @ POINT OF CARE 2018. [DOI: 10.1177/2399202618799691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Gillian Prue
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
- HPV Action, Rugby, UK
| | - David Grimes
- School of Mathematics and Physics, Queen’s University Belfast, Belfast, UK
| | | | - Mark Lawler
- HPV Action, Rugby, UK
- European Cancer Concord and Centre for Cancer Research & Cell Biology, Queen’s University Belfast, Belfast, UK
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42
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Merriel SW, Nadarzynski T, Kesten JM, Flannagan C, Prue G. 'Jabs for the boys': time to deliver on HPV vaccination recommendations. Br J Gen Pract 2018; 68:406-407. [PMID: 30166370 PMCID: PMC6104855 DOI: 10.3399/bjgp18x698429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Samuel Wd Merriel
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Tom Nadarzynski
- Department of Psychology, University of Southampton, Southampton
| | - Joanna M Kesten
- Bristol Medical School, University of Bristol, Bristol. Senior Research Associate in Social Science, National Institute for Health Research (NIHR) Health Protection Research Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, Bristol; NIHR Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol
| | - Carrie Flannagan
- Institute of Nursing and Health Research, Ulster University, Londonderry
| | - Gillian Prue
- School of Nursing and Midwifery, Queens University, Belfast
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Jones CM, Adams R, Downing A, Glynne-Jones R, Harrison M, Hawkins M, Sebag-Montefiore D, Gilbert DC, Muirhead R. Toxicity, Tolerability, and Compliance of Concurrent Capecitabine or 5-Fluorouracil in Radical Management of Anal Cancer With Single-dose Mitomycin-C and Intensity Modulated Radiation Therapy: Evaluation of a National Cohort. Int J Radiat Oncol Biol Phys 2018; 101:1202-1211. [PMID: 29859793 DOI: 10.1016/j.ijrobp.2018.04.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 04/03/2018] [Accepted: 04/11/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE Chemoradiation therapy (CRT) with mitomycin C (MMC) and 5-fluorouracil (5-FU) is established as the standard of care for the radical treatment of patients with anal squamous cell carcinoma (ASCC). The use of the oral fluoropyrimidine-derivative capecitabine is emerging as an alternative to 5-FU despite limited evidence of its tolerability and toxicity. METHODS AND MATERIALS A national cohort evaluation of ASCC management within the United Kingdom National Health Service was undertaken from February to July 2015. The toxicity rates were prospectively recorded. For the present analysis, we report data from ASCC patients who underwent intensity modulated RT and a single dose of MMC with either 5-FU (5-FU/MMC) or capecitabine (capecitabine/MMC). All were treated with radical intent and intensity modulated radiation therapy (IMRT) was delivered in accordance with UK guidance. RESULTS Of the 242 patients received from 40 centers across the United Kingdom, 147 met the inclusion criteria; 52 of whom were treated with capecitabine/MMC and 95 with 5-FU/MMC. No treatment-related deaths and no overall difference were found in the proportion of patients experiencing any grade ≥3 toxicity between the capecitabine and 5-FU groups (45% vs 55%; P = .35). However, significantly fewer patients in the capecitabine/MMC group experienced grade 3 hematologic toxicity (4% vs 27%; P = .001). A lower proportion of patients completed their planned chemotherapy course in the capecitabine cohort, although this did not reach statistical significance (81% vs 90%; P = .21). The median RT duration was 38 days (interquartile range 38-39) for both groups. No difference was found in the 1-year oncologic outcomes. CONCLUSIONS Capecitabine/MMC resulted in similar levels of grade 3/4 toxicity overall compared with 5-FU/MMC as CRT for ASCC, although differences were found in the patterns of observed toxicities, with less hematologic toxicity with capecitabine. Further studies of capecitabine/MMC are required to understand the acute toxicity profile and long-term oncologic outcomes of this combination with intensity modulated RT for ASCC.
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Affiliation(s)
- Christopher M Jones
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom; Radiotherapy Research Group, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Richard Adams
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom; Velindre Hospital, Cardiff, United Kingdom
| | - Amy Downing
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Rob Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, United Kingdom
| | - Mark Harrison
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, United Kingdom
| | - Maria Hawkins
- CRUK MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - David Sebag-Montefiore
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom; Radiotherapy Research Group, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Duncan C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Rebecca Muirhead
- Oxford Cancer and Haematology Centre, Oxford University Hospitals, Oxford, United Kingdom.
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Fish R, Sanders C, Ryan N, der Veer SV, Renehan AG, Williamson PR. Systematic review of outcome measures following chemoradiotherapy for the treatment of anal cancer (CORMAC). Colorectal Dis 2018; 20:371-382. [PMID: 29566456 PMCID: PMC5969105 DOI: 10.1111/codi.14103] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/26/2018] [Indexed: 12/18/2022]
Abstract
AIM Six Phase III randomized trials have determined the effectiveness of chemoradiotherapy as primary treatment for anal squamous cell carcinoma (ASCC), but outcomes reported in these trials varied widely, hindering evidence synthesis. To improve reporting in all future trials, we aim to develop a core outcomes set (COS). As the first stage of COS development, we undertook a systematic review to summarize the outcomes reported in studies evaluating chemoradiotherapy for ASCC. METHOD Systematic literature searches identified studies evaluating radiotherapy or chemoradiotherapy for ASCC. Outcomes and accompanying definitions were extracted verbatim and categorized into domains. RESULTS From 5170 abstracts, we identified 95 eligible studies, reporting 1192 outcomes and 533 unique terms. We collapsed these terms into 86 standardized outcomes and five domains: survival; disease activity; life impact [including quality of life (QoL)]; delivery of care; and toxicity. The most commonly reported domains were survival and disease activity, reported in 74 (86%) and 54 (62%) studies, respectively. No outcome was reported in every publication. Over half (43/86) of the standardized outcome terms were reported in fewer than five studies, and 21 (25%) were reported in a single study only. There was wide variation in definitions of disease-free survival, colostomy-free survival and progression-free survival (PFS). Anal continence was reported in only 35 (41%) studies. CONCLUSION Outcomes reported in studies evaluating chemoradiotherapy for ASCC were heterogenous and definitions varied widely. Outcomes likely to be important to patients, such as ano-rectal function, toxicity and QoL, have been neglected. A COS for future trials will address these issues.
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Affiliation(s)
- R. Fish
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Peritoneal and Colorectal Oncology CentreChristie NHS Foundation TrustManchesterUK
| | - C. Sanders
- Centre for Primary CareUniversity of ManchesterManchesterUK
| | - N. Ryan
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and Health Fifth Floor ‐ ResearchSt Mary's HospitalUniversity of ManchesterManchesterUK
| | - S. Van der Veer
- Centre for Health InformaticsInformatics, Imaging and Data ScienceSchool of Health SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Farr Institute of Health Informatics ResearchHealth eResearch CentreUniversity of ManchesterManchesterUK
| | - A. G. Renehan
- Division of Cancer SciencesSchool of Medical SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Peritoneal and Colorectal Oncology CentreChristie NHS Foundation TrustManchesterUK
| | - P. R. Williamson
- MRC North West Hub for Trials Methodology ResearchDepartment of BiostatisticsUniversity of LiverpoolLiverpoolUK
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Hosni A, Han K, Le LW, Ringash J, Brierley J, Wong R, Dinniwell R, Brade A, Dawson LA, Cummings BJ, Krzyzanowska MK, Chen EX, Hedley D, Knox J, Easson AM, Lindsay P, Craig T, Kim J. The ongoing challenge of large anal cancers: prospective long term outcomes of intensity-modulated radiation therapy with concurrent chemotherapy. Oncotarget 2018; 9:20439-20450. [PMID: 29755663 PMCID: PMC5945520 DOI: 10.18632/oncotarget.24926] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/27/2018] [Indexed: 01/22/2023] Open
Abstract
Purpose Patterns of failure and long term outcomes were prospectively evaluated following tumor factors-stratified radiation dose for anal/perianal cancer. Methods Between 2008-2013, patients with anal/perianal squamous cell carcinoma were accrued to an institutional REB-approved prospective study. All patients were treated with image-guided intensity-modulated radiation therapy (IG-IMRT). Radiation dose selection (27-36 Gy for elective target, and 45-63 Gy for gross target) was based on tumor clinico-pathologic features. Chemotherapy regimen was 5-fluorouracil/mitomycin-C (weeks 1&5). Local [LF], regional failure [RF], distant metastasis [DM], overall- [OS], disease-free [DFS], colostomy-free survival [CFS] and late toxicity were analyzed. Results Overall, 101 patients were evaluated; median follow-up: 56.5 months; 49.5% male; 34.7% T3/4-category, and 35.6% N+. Median radiation dose was 63 Gy. The most common acute grade ≥3 toxicities were skin (41.6%) and hematological (30.7%). Five-year OS, DFS, CFS, LF, RF, DM rates were 83.4%, 75.7%, 74.7, 13.9%, 4.6% and 5% respectively. Five-year LF for patients with T1-2 and T3-4 disease were 0% and 39.2% respectively. All LF (n = 14, after 63 Gy, in tumors ≥5 cm) were in the high dose volume except one marginal to the high dose volume. All RF (n = 4) were within elective dose volume except one within the high dose volume. On multivariable analysis, T3/4-category predicted for poor DFS, CFS and OS. The overall late grade ≥3 toxicity was 36.2% (mainly anal [20%]). Conclusions Individualized radiation dose selection using IG-IMRT resulted in good long term outcomes. However, central failures remain a problem for locally advanced tumors even with high dose radiation (63 Gy/7weeks).
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Affiliation(s)
- Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kathy Han
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jolie Ringash
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - James Brierley
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Rebecca Wong
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert Dinniwell
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anthony Brade
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Laura A Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bernard J Cummings
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Monika K Krzyzanowska
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Eric X Chen
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David Hedley
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jennifer Knox
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alexandra M Easson
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Patricia Lindsay
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Tim Craig
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John Kim
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Merriel SWD, Flannagan C, Kesten JM, Shapiro GK, Nadarzynski T, Prue G. Knowledge and Attitudes of General Practitioners and Sexual Health Care Professionals Regarding Human Papillomavirus Vaccination for Young Men Who Have Sex with Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E151. [PMID: 29346307 PMCID: PMC5800250 DOI: 10.3390/ijerph15010151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 11/22/2022]
Abstract
Men who have sex with men (MSM) may be at higher risk for human papillomavirus (HPV)-associated cancers. Healthcare professionals' recommendations can affect HPV vaccination uptake. Since 2016, MSM up to 45 years have been offered HPV vaccination at genitourinary medicine (GUM) clinics in a pilot programme, and primary care was recommended as a setting for opportunistic vaccination. Vaccination prior to potential exposure to the virus (i.e., sexual debut) is likely to be most efficacious, therefore a focus on young MSM (YMSM) is important. This study aimed to explore and compare the knowledge and attitudes of UK General Practitioners (GPs) and sexual healthcare professionals (SHCPs) regarding HPV vaccination for YMSM (age 16-24). A cross-sectional study using an online questionnaire examined 38 GPs and 49 SHCPs, including 59 (67.82%) females with a mean age of 40.71 years. Twenty-two participants (20 SHCPs, p < 0.001) had vaccinated a YMSM patient against HPV. GPs lack of time (25/38, 65.79%) and SHCP staff availability (27/49, 55.10%) were the main reported factors preventing YMSM HPV vaccination. GPs were less likely than SHCPs to believe there was sufficient evidence for vaccinating YMSM (OR = 0.02, 95% CI = 0.01, 0.47); less likely to have skills to identify YMSM who may benefit from vaccination (OR = 0.03, 95% CI = 0.01, 0.15); and less confident recommending YMSM vaccination (OR = 0.01, 95% CI = 0.00, 0.01). GPs appear to have different knowledge, attitudes, and skills regarding YMSM HPV vaccination when compared to SHCPs.
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Affiliation(s)
- Samuel W D Merriel
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
| | - Carrie Flannagan
- Institute of Nursing and Health Research, Londonderry BT52 1SA, UK.
| | - Joanna M Kesten
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
- The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK.
| | - Gilla K Shapiro
- Department of Psychology, McGill University, Montreal, QC H3A 1A2, Canada.
| | - Tom Nadarzynski
- Department of Psychology, University of Southampton, Southampton SO17 1BJ, UK.
| | - Gillian Prue
- School of Nursing and Midwifery, Queens University, Belfast BT7 1NN, UK.
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Reali C, Guy R, Darby C, Cogswell L, Hompes R. Complex Reconstruction with Flaps After Abdominoperineal Resection and Groin Dissection for Anal Squamous Cell Carcinoma: A Difficult Case Involving Many Specialities. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:61-67. [PMID: 29339717 PMCID: PMC5782837 DOI: 10.12659/ajcr.906818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/16/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anal squamous cell carcinoma accounts for about 2-4% of all lower gastrointestinal malignancies, with a distant disease reported in less than 5%. Although surgical treatment is rarely necessary, this often involve large dissections and difficult reconstructive procedures. CASE REPORT We present a complex but successful case of double-flap reconstruction after abdominoperineal resection and groin dissection for anal squamous cell carcinoma (cT3N3M0) with metastatic right inguinal lymph nodes and ipsilateral threatening of femoral vessels. A multi-specialty team was involved in the operation. A vascular and plastic surgeon performed the inguinal dissection with en bloc excision of the saphenous magna and a cuff of the femoral vein, while colorectal surgeons carried out the abdominoperineal excision. The 2 large tissue gaps at the groin and perineum were covered with an oblique rectus abdominis myocutaneous flap and a gluteal lotus flap, respectively. A partially absorbable mesh was placed at the level of the anterior sheath in order to reinforce the abdominal wall, whereas an absorbable mesh was used as a bridge for the dissected pelvic floor muscles. The post-operative period was uneventful and the follow-up at 5 months showed good results. CONCLUSIONS An early diagnosis along with new techniques of radiochemotherapy allow patients to preserve their sphincter function. However, a persistent or recurrent disease needs major operations, which often involve a complex reconstruction. Good team-work and experience in specialized fields give the opportunity to make the best choices to perform critical steps during the management of complex cases.
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Affiliation(s)
- Claudia Reali
- Colorectal Unit, Oxford University Hospital, Headington, Oxford, U.K
| | - Richard Guy
- Colorectal Unit, Oxford University Hospital, Headington, Oxford, U.K
| | - Chris Darby
- Department of Vascular Surgery, Oxford University Hospitals, Headington, Oxford, U.K
| | - Lucy Cogswell
- Department of Plastic Surgery, Oxford University Hospitals, Headington, Oxford, U.K
| | - Roel Hompes
- Colorectal Unit, Oxford University Hospital, Headington, Oxford, U.K
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Fish R, Sanders C, Williamson PR, Renehan AG. Core outcome research measures in anal cancer (CORMAC): protocol for systematic review, qualitative interviews and Delphi survey to develop a core outcome set in anal cancer. BMJ Open 2017; 7:e018726. [PMID: 29170292 PMCID: PMC5719280 DOI: 10.1136/bmjopen-2017-018726] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The incidence of anal squamous cell carcinoma (ASCC) has increased threefold in the last 30 years. Initial treatment is chemoradiotherapy, associated with short-term and long-term side effects. Future therapy innovations aim to reduce morbidity in treatment of early tumours while maintaining treatment efficacy, and to escalate treatment intensity in locally advanced tumours with acceptable quality of life (QoL). However, all phase III randomised controlled trials to-date have utilised different primary outcomes, which hinders evidence synthesis and presents challenges to the selection of optimal outcomes in future trials. No trial comprehensively assessed long-term side effects and QoL, suggesting outcomes reflecting issues important to patients are under-represented. This project aims to determine the priority outcomes for all stakeholders and reach agreement on a standardised core set of outcomes to be measured and reported on in all future ASCC trials. METHODS AND ANALYSIS A systematic review will identify all outcomes reported in trials and observational studies of chemoradiotherapy as primary treatment for ASCC. Outcomes of importance to patients will be identified through patient interviews. The long list of outcomes generated from the systematic review and interviews will be used to create a two-round Delphi process, including key stakeholders (patients and healthcare professionals). The results of the Delphi will be discussed at a face-to-face consensus meeting. Discussion will focus on outcomes that did not achieve consensus through the Delphi process and conclude with anonymous voting to ratify the final core outcome set (COS). ETHICS AND DISSEMINATION The final COS will feed directly into the PersonaLising Anal cancer radioTherapy dOse (PLATO) national anal cancer trials and the Association of coloproctologists of Great Britain and Ireland (ACPGBI) supported national anal cancer database. Utilisation of the COS will increase the relevance of research output to all stakeholders and increase the capacity for data synthesis between trials. This study has ethical approval and is registered with the Core Outcome Measures in Effectiveness Trials (COMET) initiative. TRIAL REGISTRATION NUMBER PROSPERO registration ID: CRD42016036540.
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Affiliation(s)
- Rebecca Fish
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Caroline Sanders
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Paula R Williamson
- Department of Biostatistics, University of Liverpool, Liverpool, UK
- Medical Research Council North West Hub for Trials Methodology Research, Liverpool, UK
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
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49
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Heráclio SA, de Souza ASR, de Souza PRE, Katz L, Lima Junior SF, Amorim MMR. Cross-sectional study of anal intraepithelial lesions in women with cervical neoplasia without HIV. Int J Gynaecol Obstet 2017; 140:233-240. [PMID: 29080327 DOI: 10.1002/ijgo.12367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/22/2017] [Accepted: 10/27/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the prevalence of anal intraepithelial lesions and associated risk factors in women with cervical neoplasia. METHODS The present cross-sectional study enrolled patients with intraepithelial or invasive cervical neoplasia who had been referred to the lower genital tract pathology outpatient department of the Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil, between December 1, 2008, and December 31, 2009; patients with HIV infections were excluded. All participants underwent anal cytology and high-resolution anoscopy; sociodemographic and clinical risk factors were identified using multivariate analysis. RESULTS There were 324 patients included and 37 (11.4%) had anal intraepithelial neoplasia. Factors associated with anal intraepithelial neoplasia in the multivariate analysis were being older than 35 years of age (P=0.002), having completed no more than 4 years of education (P=0.012), anomalous anal cytology (P=0.003), and anomalous high-resolution anoscopy findings (P<0.001); subclinical HPV lesions on vulvoscopy (P=0.057) were not associated with anal intraepithelial neoplasia. CONCLUSION The prevalence of anal intraepithelial neoplasia was high among patients with cervical neoplasia who did not have HIV, particularly patients older than 35 years.
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Affiliation(s)
- Sandra A Heráclio
- Department of Pathology of the Lower Genital Tract, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil
| | - Alex S R de Souza
- Department of Fetal Medicine and Ultrasonography, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil
| | - Paulo R E de Souza
- Department of Biology, Federal Rural University of Pernambuco, Recife, PE, Brazil
| | - Leila Katz
- Department of Women's Health, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil
| | - Sergio F Lima Junior
- Department of Biology, Federal Rural University of Pernambuco, Recife, PE, Brazil
| | - Melania M R Amorim
- Department of Women's Health, Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil
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50
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Sekhar H, Zwahlen M, Trelle S, Malcomson L, Kochhar R, Saunders MP, Sperrin M, van Herk M, Sebag-Montefiore D, Egger M, Renehan AG. Nodal stage migration and prognosis in anal cancer: a systematic review, meta-regression, and simulation study. Lancet Oncol 2017; 18:1348-1359. [PMID: 28802802 DOI: 10.1016/s1470-2045(17)30456-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/01/2017] [Accepted: 06/07/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In patients with squamous cell carcinoma of the anus (SCCA), lymph node positivity (LNP) indicates poor prognosis for survival and is central to radiotherapy planning. Over the past three decades, LNP proportion has increased, mainly reflecting enhanced detection with newer imaging modalities; a process known as nodal stage migration. If accompanied by constant T stage distributions, prognosis for both lymph node-positive and lymph node-negative groups may improve without any increase in overall survival for individual patients; a paradox termed the Will Rogers phenomenon. Here, we aim to systematically evaluate the impact of nodal stage migration on survival in SCCA and address a novel hypothesis that this phenomenon results in reduced prognostic discrimination. METHODS We did a systematic review and meta-regression to quantify changes in LNP over time and the impact of this change on survival and prognostic discrimination. We searched MEDLINE, Embase, and the Cochrane Library to identify randomised trials and observational studies in patients with SCCA published between Jan 1, 1970, and Oct 11, 2016. Studies were eligible if patients received chemoradiotherapy or radiotherapy as the main treatment, reported LNP proportions (all studies), and reported overall survival (not necessarily present in all studies). We excluded studies with fewer than 50 patients. We extracted study-level data with a standardised, piloted form. The primary outcome measure was 5-year overall survival. To investigate scenarios in which reduced prognostic discrimination might occur, we simulated varying true LNP proportions and true overall survival, and compared these with expected observed outcomes for varying levels of misclassification of true nodal state. FINDINGS We identified 62 studies reporting LNP proportions, which included 10 569 patients. From these, we included 45 studies (6302 patients) with whole cohort 5-year overall survival, 11 studies with 5-year survival stratified by nodal status, and 20 studies with hazard ratios in our analyses of temporal changes. In 62 studies, the LNP proportions increased from a mean estimate of 15·3% (95% CI 10·5-20·1) in 1980 to 37·1% (34·0-41·3) in 2012 (p<0·0001). In 11 studies with prognostic data, increasing LNP was associated with improved overall survival in both lymph node-positive and lymph node-negative categories, whereas the proportions with combined tumour stage T3 and T4 remained constant. In 20 studies, across a range of LNP proportions from 15% to 40%, the hazard ratios for overall survival of lymph node-positive versus lymph node-negative patients decreased significantly from 2·5 (95% CI 1·8-3·3) at 15% LNP to 1·3 (1·2-1·9; p=0·014) at 40% LNP. The simulated scenarios reproduced this effect if the true LNP proportions were 20% or 25%, but not if the true LNP proportions were 30% or greater. INTERPRETATION We describe a consequence of staging misclassification in anal cancer that we have termed reduced prognostic discrimination. We used this new observation to infer that the LNP proportions of more than 30% seen in modern clinical series (11 out of 15 studies with a median year since 2007) are higher than the true LNP proportion. The introduction of new staging technologies in oncology might misclassify true disease stage, spuriously informing disease management and ultimately increasing the risk of overtreatment. FUNDING Bowel Disease Research Foundation.
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Affiliation(s)
- Hema Sekhar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Sven Trelle
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Lee Malcomson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Rohit Kochhar
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mark P Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Sperrin
- Farr Institute, MRC Health eResearch Centre (HeRC), Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Marcel van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - David Sebag-Montefiore
- Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Andrew G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK.
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