Boosting the Amount of Concurrent Chemoradiotherapy Administered to Patients With ASCC May Improve Efficacy

Increasing the dose of the primary treatment modality for anal squamous cell carcinoma, chemoradiotherapy, may further improve efficacy for patients with effective organ preservation and disease control.

Increasing the dose of the primary treatment modality for anal squamous cell carcinoma, chemoradiotherapy, may further improve efficacy for patients with effective organ preservation and disease control, according to retrospective data presented in a poster during the ESMO World Congress on Gastrointestinal Cancer 2021.

While anal cancer is an uncommon gastrointestinal malignancy, it has a high cure rate with a non-surgical cancer approach, allowing for organ preservation. An increased dose of chemo-radiotherapy and early stoma reversal may help to improve survival and overall quality of life. 

The current standard of care for anal cancer is chemoradiation. However, treatment for this cancer type is often limited to specialists’ centers. The 10-year retrospective study aimed to determine the efficacy of concurrent chemoradiation in locally advanced anal squamous cell carcinoma (ASCC).

The retrospective looked at data on patients diagnosed with ASCC who had completed the full course of chemo-radiotherapy between 2008 and 2017. The chemotherapy used was mitomycin C with 5FU or capecitabine. Some of the patients included in the analysis received adjuvant chemotherapy while others received neoadjuvant chemotherapy. All data included was gathered retrospectively by analyzing basic demographics, staging, surgery, relapse, latest follow-up, date of death, as well as the chemo-radiation.

In total, 87 patients with a median age of 60 were included in the analysis. At diagnosis, the vast majority, 94.3% had T2-T4 disease and nearly half, 44.8% had nodal involvement from positive locoregional lymph nodes. The overall survival (OS) probability at 3 years was 87.4% and 83.5% at 5 years.

The analysis also found a statistically significant effect on the time of diagnosis to the start of radiotherapy on OS. Sixty-nine percent of patients achieved complete remission at their last follow-up.

In terms of relapse, 3 patients experience a local relapsed and 9 patients experienced a systemic relapse. An additional 6 patients had persistent disease. The mean time to relapse was 16 months. Those who relapsed had a median OS of 52.3 months.

Of the 21 patients (24%) who underwent surgery for a defunctioning stoma, only 5 of them received a subsequent stoma reversal.

According to the analysis, early stoma reversal may help to improve patient quality of life. Further studies should investigate the theory of using an increased dose of chemoradiotherapy to improve outcomes even further.

REFERENCE:
Elmasry, A. Patel C, Lim Z et al. Concurrent chemo-radiotherapy in anal squamous cell carcinomas: A 10-year retrospective review of tertiary centre experience. Abstract presented at: ESMO World Congress on Gastrointestinal Cancer. June 30-July 3. Virtual. Accessed June 20, 2021. Abstract P-20.