Anal canal carcinoma: early-stage tumors < or =10 mm (T1 or Tis): therapeutic options and original pattern of local failure after radiotherapy.

Abstract

PURPOSE:

To investigate the clinical history, management, and pattern of recurrence of very early-stage anal canal cancer in a French retrospective survey.

METHODS:

The study group consisted of 69 patients with Stage Tis and T1 anal canal carcinoma < or =1 cm treated between 1990 and 2000 (12 were in situ, 57 invasive, 66 Stage N0, and 3 Stage N1). The median patient age was 67 years (range, 27-83 years). Of the 69 patients, 66 received radiotherapy (RT) and 3 with in situ disease were treated by local excision alone without RT. Twenty-six patients underwent local excision before RT (12 with negative and 14 with positive surgical margins). Of the 66 patients who underwent RT, 8 underwent brachytherapy alone (median dose, 55 Gy), 38 underwent external beam RT (median dose, 45 Gy) plus a brachytherapy boost (median boost dose, 20 Gy), and 20 underwent external beam RT alone (median dose, 55 Gy).

RESULTS:

Of the 69 patients, 68 had initial local control. Of the 66 patients treated by RT, 6 developed local recurrence at a median interval of 50 months (range, 13-78 months). Four patients developed local failure outside the initial tumor bed. Of the 3 patients with Tis treated by excision alone, 1 developed local recurrence. No relation was found among prior excision, dose, and local failure. The 5-year overall survival, colostomy-free survival, and disease-free survival rate was 94%, 85%, and 89%, respectively. The rate of late complications (Grade 1-3) was 28% and was 14% for those who received doses <60 Gy and 37% for those who received doses of > or =60 Gy (p = 0.04).

CONCLUSION:

Most recurrences occurred after a long disease-free interval after treatment and often outside the initial tumor site. These small anal cancers could be treated by RT using a small volume and moderate dose (40-50 Gy for subclinical lesions and 50-60 Gy for T1).

• Authors: Cécile Ortholan, Alain Ramaioli, Didier Peiffert, Antoine Lusinchi, Pascale Romestaing, Laurent Chauveinc, Emmanuel Touboul, Karine Peignaux, Antoine Bruna, Guy de La Roche, Jean-Léon Lagrange, Christian Alzieu, Jean Pierre Gerard
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 62 Issue 2 Pg. 479-85 (Jun 01 2005) ISSN: 0360-3016 [Print] United States
• PMID: 15890590 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Anal Canal (physiology)
• Anus Neoplasms (pathology, radiotherapy, surgery)
• Carcinoma in Situ (pathology, radiotherapy, surgery)
• Carcinoma, Squamous Cell (pathology, radiotherapy, surgery)
• Carcinoma, Transitional Cell (pathology, radiotherapy, surgery)
• Chi-Square Distribution
• Disease-Free Survival
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Radiotherapy Dosage