Cure Rates According to Dose-Intensity of Chemoradiation in T2N0 Squamous Cell Carcinoma of the Anal Canal



      Patients with T2N0 squamous cell carcinoma of the anal canal (SCCA) have comprised less than 30% of patients enrolled in phase III clinical trials of curative-intent definitive chemoradiation. We aimed to evaluate treatment outcomes of these patients according to dose-intensity of chemoradiation.

      Materials and Methods

      Retrospective multicenter study of patients with T2N0 SCCA, with the primary endpoint to compare the progression-free survival (PFS) of patients treated with full definitive chemoradiotherapy (f-CRT, CRT with 2 drugs) versus a nonstandard treatment (NST; radiotherapy only or CRT with 1 drug). Secondary outcomes were rates of complete response (CR), salvage surgery, and colostomy. PFS time was analyzed using the Kaplan-Meier method and differences in survival outcomes were assessed using the log-rank test and adjusted for prognostic covariates using a multivariable Cox regression model


      From March 2006 to January 2020, 74 patients were included. Most patients (n = 58; 78.4%) received f-CRT. In a median follow up time of 66.1 months, the unadjusted median PFS was 128.3 months (95% confidence interval [CI] 105.5-151.1) for f-CRT versus 74.1 months for NST (95% CI 45.8-102.4; P = .067). CR was achieved by 51 (87.9%) versus 11 (68.9%; P = .065) patients treated with f-CRT or an NST, respectively. Comparing f-CRT versus NST, the colostomy rates were higher for those treated with an NST: 5 (32.8%) versus 5 (9.5%; P = .019)


      For patients with T2N0 SCCA, f-CRT remains the standard treatment, offering higher CR and less likelihood of colostomy.


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        • Siegel RL
        • Miller KD
        • Jemal A
        Cancer statistics, 2020.
        CA Cancer J Clin. 2020;
        • Sung H
        • Ferlay J
        • Siegel RL
        • et al.
        Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
        CA Cancer J Clin. 2021;
        • James RD
        • Glynne-Jones R
        • Meadows HM
        • et al.
        Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2×2 factorial trial.
        Lancet Oncol. 2013; 14: 516-524
        • Camandaroba MPG
        • Iseas S
        • Oliveira C
        • et al.
        Disease-free survival and time to complete response after definitive chemoradiotherapy for squamous-cell carcinoma of the anus according to HIV infection.
        Clin Colorectal Cancer. 2020;
        • Northover JMA
        • Arnott SJ
        • Cunningham D
        • et al.
        Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin.
        Lancet. 1996;
        • Doyen J
        • Benezery K
        • Follana P
        • et al.
        Predictive factors for early and late local toxicities in anal cancer treated by radiotherapy in combination with or without chemotherapy.
        Dis Colon Rectum. 2013;
        • Bentzen AG
        • Guren MG
        • Vonen B
        • et al.
        Faecal incontinence after chemoradiotherapy in anal cancer survivors: long-term results of a national cohort.
        Radiother Oncol. 2013;
        • Deniaud-Alexandre E
        • Touboul E
        • Tiret E
        • et al.
        Results of definitive irradiation in a series of 305 epidermoid carcinomas of the anal canal.
        Int J Radiat Oncol Biol Phys. 2003;
        • Zilli T
        • Schick U
        • Ozsahin M
        • Gervaz P
        • Roth AD
        • Allal AS
        Node-negative T1-T2 anal cancer: radiotherapy alone or concomitant chemoradiotherapy?.
        Radiother Oncol. 2012;
        • Flam M
        • John M
        • Pajak TF
        • et al.
        Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: Results of a phase III randomized intergroup study.
        J Clin Oncol. 1996;
        • Bartelink H
        • Roelofsen F
        • Eschwege F
        • et al.
        Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: Results of a phase III randomized trial of the European organization for research and treatment of cancer radiotherapy and gastro.
        J Clin Oncol. 1997;
        • Northover J
        • Meadows H
        • Ryan C
        • Gray R
        Combined radiotherapy and chemotherapy for anal cancer.
        Lancet. 1997;
        • Miller E
        • Nalin A
        • Pardo DD
        • et al.
        Stage I squamous cell carcinoma of the anus: Is radiation therapy alone sufficient treatment?.
        Cancers (Basel). 2020;
        • Riechelmann RP
        • Camandaroba M
        • Mello CA
        • Aguiar S
        402P Chemoradiation versus less intensive treatments in stage I squamous cell carcinoma of the anal canal (SCCA).
        Ann Oncol. 2021;
        • Miller E
        • Bazan J
        De-escalation of therapy for patients with early-stage squamous cell carcinoma of the anus.
        Cancers (Basel). 2021;
        • Moniz CMV
        • Riechelmann RP
        • Ribeiro SC
        • et al.
        Prospective study of biomarkers in squamous cell carcinoma of the anal canal (SCCAC) and their influence on treatment outcomes: Final results.
        J Clin Oncol. 2017;
        • Camandaroba MPG
        • Araujo RLC de
        • Silva VS e
        • Mello CAL de
        • Riechelmann RP
        Treatment outcomes of patients with localized anal squamous cell carcinoma according to HIV infection: systematic review and meta-analysis.
        J Gastrointest Oncol. 2018; 10: 48-60
        • Serup-Hansen E
        • Linnemann D
        • Skovrider-Ruminski W
        • Hgødall E
        • Geertsen PF
        • Havsteen H
        Human papillomavirus genotyping and p16 expression as prognostic factors for patients with American Joint Committee on Cancer stages I to III carcinoma of the anal canal.
        J Clin Oncol. 2014;