Chemoradiotherapy for squamous cell carcinoma of the anal canal: Comparison of one versus two cycles mitomycin-C. Issue 2 (November 2015)

• Record Type: Journal Article
• Authors: White, Evan C.; Goldman, Kelly; Aleshin, Alexey; Lien, Winston W.; Rao, Aroor R.
• Is Part Of: Radiotherapy and oncology. Volume 117:Issue 2(2015:Nov.)
• Page Start: 240
• Page End: 245
• Publication Date: 2015-11
• Subjects: Anal cancer -- Radiation therapy -- Mitomycin-c -- Toxicity -- Outcomes; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2015.08.015
• Languages: English
• ISSNs: 0167-8140

Abstract

Abstract: Background and purpose: Concurrent chemoradiotherapy with 5-fluorouracil (5-FU) and mitomycin-C (MMC) is standard treatment for anal cancer. Randomized clinical trials in Europe have used 1 cycle MMC, while North American studies use 2 cycles. We compared treatment outcomes between patients treated with either 1 or 2 cycles of concurrent MMC. Material and methods: 217 consecutive patients were treated definitively with chemoradiation from 2004 to 2012 in an integrated health system. Concurrent chemotherapy regimen depended on individual practice, and consisted of 2 cycles 5-FU (1000 mg/m 2 /day on days 1–4 and 29–32), along with MMC (10–15 mg/m 2 ), given on either day 1 alone ( n = 154), or days 1 and 29 ( n = 63). Outcomes included progression-free (PFS), cancer-specific (CSS), overall (OS), and colostomy-free survival (CFS), as well as toxicity criteria. Results: Median age 60 years, 70% female, 52% T3–T4, and 40% node-positive. Median follow-up 26 months. At 2 years, outcomes were: PFS 80%, CSS 89%, OS 86%, and CFS 88%. There was no difference in PFS (HR 0.85, 95% CI 0.37–1.92), CSS (HR 0.32, 95% CI 0.07–1.42), OS (HR 0.67, 95% CI 0.25–1.83), or CFS (HR 0.91, 95% CI 0.31–2.67) between the MMC1 and MMC2 groups. Stage and male gender were predictive of worse outcomes. Acute grade ⩾2 toxicities were worse in the MMC2 group. There were 3 treatment-related deaths, all in the MMC2 group. Conclusions: This study suggests that MMC1 is efficacious and may be an alternative to MMC2 in patients with anal cancer treated with definitive chemoradiation, with the potential for less acute treatment-related toxicity. Randomized trials comparing these two regimens could be considered.