41 Combined radio-chemotherapy of anal cancer experiences from a single institution

3572 Background: Anal cancer is an uncommon malignancy with numerous factors that influence treatment outcomes. Historically, HIV+ patients were restricted from entering clinical trials, limiting data on their outcomes to small retrospective reports. This study seeks to understand the factors related to anal cancer outcomes, specifically the differences between HIV+ and HIV- patients. Methods: Inclusion criteria was non-metastatic anal squamous cell carcinoma treated with a definitive course of chemotherapy and radiation between 2005 and 2018 at a single institution. Clinical data related to baseline characteristics, treatment parameters, and post-treatment follow-up were extracted for calculation of freedom from local recurrence (FFLR) and overall survival (OS). Univariate analysis (UVA) and multivariate analysis (MVA) were done using cox proportional hazard model, and FFLR and OS were calculated using the Kaplan-Meier method. Results: During the study period, 111 patient initiated definitive treatment for anal cancer. Median age was 56.7 years (IQR: 51.4-63.5), and 47% (N = 52) were HIV+. At median follow-up of 28 months, 12 and 24-month FFLR was 84.1% and 78.2% respectively, with 24-month OS of 87.3%. MVA demonstrated significant association between FFLR and T-stage HR 4.02 (95% CI: 2.14-7.55) p < 0.001, elapsed treatment time (median of 50 days) 1.08 (95% CI: 1.04-1.12) p < 0.001, and diagnosis to treatment start (median time of 15 weeks) 1.05 (95% CI: 1.01-1.08) p = 0.005. Additional analysis with log-rank test for FFLR demonstrated significant difference between patients taking < 50 days to complete treatment (p = 0.03), and < 15 weeks from diagnosis to treatment completion (p = 0.006). In HIV+ patients, post-treatment CD4 < 150 was significantly associated with worse OS on log-rank test (p = 0.016), with pretreatment CD4 values being non-significant. Conclusions: This study represents the largest single institution report of HIV positive patients treated for anal cancer. No difference in local recurrence or overall survival between HIV+ and HIV- patients was elucidated; however, HIV+ patients with lower post-treatment CD4 counts had worse OS. The most significant predictors of local recurrence were advanced T-stage, increased time from diagnosis to treatment initiation, and prolonged treatment time.

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Radio-chemotherapy in anal cancer: Institutional experience at a large radiation oncology center in Chile

Reports of Practical Oncology & Radiotherapy ◽

10.1016/j.rpor.2014.02.001 ◽

2014 ◽

Vol 19 (4) ◽

pp. 230-233 ◽

Cited By ~ 2

Author(s):

Moisés Russo ◽

Valentina Ovalle

Keyword(s):

Anal Cancer ◽

Radiation Oncology ◽

Institutional Experience ◽

Radio Chemotherapy ◽

Oncology Center

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6628 Node negative T1–2 anal cancer: radiotherapy alone or concomitant radio-chemotherapy?

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(09)71349-7 ◽

2009 ◽

Vol 7 (2) ◽

pp. 398

Author(s):

T. Zilli ◽

U. Schick ◽

M. Ozsahin ◽

P. Gervaz ◽

A. Roth ◽

...

Keyword(s):

Anal Cancer ◽

Cancer Radiotherapy ◽

Node Negative ◽

Radiotherapy Alone ◽

Radio Chemotherapy

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1051 poster CLINICAL OUTCOMES IN ANAL CANCER: A SINGLE INSTITUTION EXPERIENCE

Radiotherapy and Oncology ◽

10.1016/s0167-8140(11)71173-2 ◽

2011 ◽

Vol 99 ◽

pp. S391-S392

Author(s):

S. Ahmad ◽

R. Soomal

Keyword(s):

Clinical Outcomes ◽

Anal Cancer ◽

Single Institution

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HPV status to predict outcome for anal cancer treated with radiochemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.4065 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 4065-4065

Author(s):

Sabine Kathrin Mai ◽

Miriam Reuschenbach ◽

Martine Ottstadt ◽

Grit Welzel ◽

Marcus Trunk ◽

...

Keyword(s):

Multivariate Analysis ◽

Treatment Regimen ◽

Anal Cancer ◽

Univariate Analysis ◽

Hpv Infection ◽

Clear Trend ◽

T Stage ◽

Hpv Status ◽

Group 2 ◽

Radio Chemotherapy

4065 Background: Evaluation of the HPV infection- and transformation-status as a predictor of the response to definitive radio-chemotherapy for anal cancer. Methods: 80 patients (54 fm, 26 m) with histologically confirmed anal cancer and known HPV-Infection- (determined by PCR) and p16-expression-status (determined by immunohistochemistry) were analyzed. All pts. were treated with definitive radio-chemotherapy (RCT) with 5-FU/MMC, median age 60ys (35–86), median follow up 54mo (4–180). 41 pts. were HPV+ and p16+ (group 1), 10 pts. were HPV-/p16+ (group 2), 9 pts. were HPV+/p16- (group 3) and 17 pts. were HPV+/p16- (group 4). Endpoints were local control (LC) at 5ys and overall survival (OS) at 5ys. In addition to HPV/p16 status, the influence of T-stage and tumor localization (canal vs. margin) was analyzed. Results: More women than men were HPV+ (fm 77% vs. m 33%) while gender was evenly distributed among HPV-pts. (fm 48% vs. m 53%). Upon univariate analysis, gender, HPV+ and p16+ were significant predictors of both LC and OS (p<0.05) while T-Stage was predictive for LC (p<0.05). Upon multivariate analysis, gender and T-Stage significantly influenced LC (w85.2% vs. m54.9%, p=0.028; <T3 84.2% vs ≥ T3 48,1%, p=0,019). OS was significantly influenced by gender (w95% vs. m59.2%, p=0.005), while the influence of HPV/p16-status did not reach significance when all four groups were analyzed simultaneously in this moderately sized cohort. Upon direct univariate comparison of HPV+/p16+ und HPV-/p16-pts, both gender and combined HPV/p16-positivity had a significant influence on LC and OS. Upon multivariate analysis, combined HPV/p16-positivity resulted in better LC (HPV+/p16+: 85% vs. HPV-/p16-: 38.7%, p=0.003), while, as a consequence of moderate patient numbers, only gender significantly predicted OS (fm93.7% vs. m62.6%, p=0.015). Viral status, however, showed a trend for significance. Conclusions: The data from one of the largest monocentric series treated with a uniform treatment regimen suggest that HPV-status predicts response to RCT in pts. with anal cancer. Patients with tumors not associated with HPV whatsoever (HPV-/P16-) have both inferior LC and a clear trend for inferior OS and might require an intensified treatment regimen.

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