What is the optimal treatment for T1N0 anal squamous cell carcinoma? Analysis of current practices in the prospective French FFCD ANABASE cohort. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Bacci, Manon; Quero, Laurent; Barbier, Emilie; Parrot, Laurène; Juguet, Frédéric; Pommier, Pascal; Bazire, Louis; Etienney, Isabelle; Baba-Hamed, Nabil; Spindler, Lucas; François, Eric; Ronchin, Philippe; Campo, Eleonor Rivin Del; Lemanski, Claire; Lièvre, Astrid; Siproudhis, Laurent; Abramowitz, Laurent; Lepage, Côme; Vendrely, Véronique
• Is Part Of: Digestive and liver disease. Volume 53:Issue 6(2021)
• Page Start: 776
• Page End: 784
• Publication Date: 2021-06
• Subjects: Anal canal carcinoma -- T1N0M0 cancer -- Radiotherapy -- Chemoradiotherapy -- Local excision; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2021.03.015
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Introduction: for localized T1N0 squamous cell carcinoma of the anus (SCCA) standard radiotherapy (RT) may result in overtreatment and alternative strategies are debated. Methods: T1N0M0 SCCA treated between 2015 and 2020 by local excision (LE) or RT were analyzed from the French prospective FFCD ANABASE cohort. Treatment strategies, recurrence-free and colostomy-free survivals (RFS, CFS) and prognostic factors were reported. Results: among 1135 SCCA patients, 99 T1N0M0 were treated by LE( n = 17, 17.2%), or RT ( n = 82, 82.8%) including RT alone ( n = 65, 79.2%) or chemo-RT ( n = 17, 20.7%). Median follow-up was 27.2 months [0.03–54.44]. Median tumor size were 11.4 mm [0.9–20] and 15.3 mm [2–20] in the LE and RT groups respectively. Mean RT tumor dose was 59.4 Gy [18–69.4 Gy]. One patient in LE group and 9 in RT group had a pelvic recurrence, either local (60%), nodal (10%) or both (30%). RFS and CFS at 24 months were 92.2%[95%CI, 83.4–96.4] and 94.6%[95%CI, 86.1–98.0], at 36 months 88.1%[95%CI, 77.1–94.2] and 88.5%[95%CI, 77.0–94.5], in LE and RT group respectively, without any significative difference (HR = 0.57;[95%CI, 0.07–4.45]; p = 0.60). By univariate analysis, male gender was the only prognostic factor(HR = 5.57;95%CI, 1.76–17.63; p = 0.004). Conclusion: this cohort confirms the heterogeneity of T1N0M0 SCCA management, questioning the place of RT alone, reduced dose or RT volume, and the safety of LE.