Squamous-cell carcinoma of the anal canal: Predictors of treatment outcome Journal Article


Authors: Roohipour, R.; Patil, S.; Goodman, K. A.; Minsky, B. D.; Wong, W. D.; Guillem, J. G.; Paty, P. B.; Weiser, M. R.; Neuman, H. B.; Shia, J.; Schrag, D.; Temple, L. K. F.
Article Title: Squamous-cell carcinoma of the anal canal: Predictors of treatment outcome
Abstract: PURPOSE: The incidence of anal canal squamous-cell carcinoma is increasing. Limited data exist on predictors of treatment failure. This study was designed to identify predictors for relapse/persistence after first-line therapy. METHODS: Using one database, we identified 131 Stages I-III patients treated for primary anal canal squamous-cell carcinoma at our institution from December 1986 to August 2006, with minimum six-month follow-up. Demographic, pathologic, treatment, and outcome data were extracted. Treatment failure was defined as biopsy-proven persistence or relapse (local and/or distant). Univariate, bivariate, and multivariate survival analyses were performed. RESULTS: Of 131 patients (median age, 58.3 years; median follow-up, 2.9 (range, 0.6-11.2) years), 66 percent were females, 43.5 percent were Stage II, and 11 (8 percent) were HIV-positive. Surgery only (local excision) was uncommon (6.9 percent, n=9). One hundred twenty-two patients (93.1 percent) received radiotherapy; two required preradiotherapy diversion. Although 114 (93.4 percent) completed radiotherapy, most required treatment breaks, making total duration of radiotherapy longer than planned. Almost all patients undergoing radiotherapy (96.7 percent, 118/122) also had chemotherapy: 118 (100 percent, Stages I-III) had concurrent chemotherapy: (98 (83.8 percent) mitomycin/5-fluorouracil, 12 (10.2 percent) cisplatin/5-fluorouracil, 8 (6.8 percent) 5-fluorouracil alone); 35 of 46 (76 percent) Stage III patients received induction chemotherapy (34 (97.1 percent) cisplatin/5-fluorouracil, 1 (2.8 percent) 5-fluorouracil alone). Many (44 percent Stages I/II, 48.9 percent Stage III) required dose adjustments. Thirty-seven patients (28.2 percent) failed first-line therapy. There were no differences between patients with relapse (n=22) or persistence (n=15) of disease. Bivariate analyses demonstrated that T stage (P=0.0019), completion of radiotherapy, and total radiotherapy dose (P=0.03) were all significantly associated with treatment failure. On multivariate analyses, disease stage (P=0.05) and completion of radiotherapy (P=0.01) remained significant predictors of relapse-free survival. CONCLUSIONS: Tolerance of chemoradiation seems to be an important predictor of treatment success. Effective therapies with less acute toxicity must be identified. © 2007 The American Society of Colon and Rectal Surgeons.
Keywords: cancer survival; treatment outcome; disease-free survival; cancer surgery; survival rate; treatment failure; retrospective studies; major clinical study; squamous cell carcinoma; carcinoma, squamous cell; cisplatin; fluorouracil; cancer combination chemotherapy; monotherapy; multimodality cancer therapy; treatment duration; cancer radiotherapy; radiation dose; combined modality therapy; human immunodeficiency virus infection; follow up; follow-up studies; neoplasm staging; neoplasm recurrence, local; incidence; tomography, x-ray computed; pathology; information processing; biopsy; time factors; predictor variable; cancer relapse; multivariate analysis; mitomycin; new york; drug treatment failure; univariate analysis; endosonography; anal canal; squamous-cell carcinoma; treatment outcomes; anus neoplasms; anus carcinoma; bivariate analysis
Journal Title: Diseases of the Colon and Rectum
Volume: 51
Issue: 2
ISSN: 0012-3706
Publisher: Lippincott Williams & Wilkins  
Date Published: 2008-02-01
Start Page: 147
End Page: 153
Language: English
DOI: 10.1007/s10350-007-9125-z
PUBMED: 18180997
PROVIDER: scopus
DOI/URL:
Notes: Erratum issued, see DOI: 10.1007/s10350-008-9216-5 - "Cited By (since 1996): 29" - "Export Date: 17 November 2011" - "CODEN: DICRA" - "Source: Scopus"
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Citation Impact
MSK Authors
  1. Sujata Patil
    488 Patil
  2. Philip B Paty
    415 Paty
  3. Bruce Minsky
    306 Minsky
  4. Karyn A Goodman
    255 Goodman
  5. Jose Guillem
    404 Guillem
  6. Deborah Schrag
    138 Schrag
  7. Heather B Neuman
    18 Neuman
  8. Jinru Shia
    586 Shia
  9. Martin R Weiser
    411 Weiser
  10. Larissa Temple
    190 Temple
  11. Douglas W Wong
    177 Wong