Chemoradiation and maintenance chemotherapy with cisplatin and 5-fluorouracil in anal squamous cell carcinoma

14057 Background: Chemoradiation is the standard treatment for anal carcinoma. Mitomycin-C (MMC) with 5-fluorouracil (5-FU) is the widely used regimen, but MMC is not a radiation sensitizer and has significant toxicities. This study was conducted to update our experience in treating anal carcinomas with an external beam radiation and continuous infusion of 5-FU with cisplatin. Methods: Twenty-eight patients with locally advanced squamous cell carcinoma of the anus were treated between 1995 and 2005. The primary tumor and involved lymph nodes received a total of 41.4–64.8 Gy and 39.6–60.4 Gy, respectively. Chemotherapy consisted of 5-FU (1,000 mg/m2 CI, D1–5 and D36–40) and cisplatin (80 mg/m2 IVF, D2 and D37) q 4weeks for 4 courses. Results: One patients had T1 lesions, 15 had T2, 7 had T3, and 5 patients had T4 disease. Seventeen patients presented with clinically detectable lymphadenopathy. Eight patients failed to start maintenance chemotherapy due to events during chemoradiation. Of the 19 patients who started maintenance chemotherapy, 3 failed to complete all four courses due to intolerance to chemotherapy. With a median follow-up duration of 68.5 months, the actuarial 5-year OS rate was 83.2 %, the DFS rate 80.7%, and the colostomy-free survival was 91.7%. Patterns of recurrence were local relapses in 3 patients, distant metastases in 2, and both in 1, respectively. Seventeen patients (60.7%) developed moist skin reaction, which frequently caused the interruption of radiotherapy. Principal grade 3/4 hematologic toxicities were neutropenia in 10 patients (35.8%) and thrombocytopenia in 4 (14.2%). The most common late complications were lymphedema (14.3%). Conclusions: Our results demonstrate that combined modality therapy with external beam radiation, cisplatin and 5-FU yields an excellent outcome in terms of survival and sphincter preservation which is comparable to the results of MMC regimens. No significant financial relationships to disclose.