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Treatment of anal carcinoma in the elderly
Author(s) -
Allal Abdelkarim S.,
Obradovic Mirjana,
Laurencet France,
Roth Arnaud D.,
Spada Alexandra,
Marti MarcClaude,
Kurtz John M.
Publication year - 1999
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19990101)85:1<26::aid-cncr4>3.0.co;2-0
Subject(s) - medicine , anal cancer , radiation therapy , concomitant , chemotherapy , carcinoma , surgery , fluorouracil , brachytherapy , cancer
BACKGROUND For most cancers, information on treatment tolerance and results for elderly patients is quite limited. This study was conducted to investigate the feasibility and results of curative nonsurgical treatment of patients age 75 years or older with anal carcinoma. METHODS From January 1976 through June 1996, invasive anal squamous cell carcinoma was diagnosed in 58 patients age ≥75 years. Curative treatment was administered to 47 patients (81%), of whom 42 received radiotherapy (RT), either used alone (21) or associated with concomitant chemotherapy (CT). RT was administered in two sequences, the first in which a median dose of 39.6 gray (Gy) was delivered with megavoltage photon beams, followed (after a median interval of 43 days) by a boost with either brachytherapy or external beam (median dose, 20 Gy). CT started on Day 1 and generally consisted of 1 cycle of mitomycin C (MMC; median dose, 9.5 mg/m 2 ) and a 96‐hour infusion of 5‐fluorouracil (5‐FU; median dose, 600 mg/m 2 /day). The median follow‐up for all patients was 48 months (range, 5–163 months). RESULTS Of 40 patients (95%) who completed curative treatment, acute toxicity resulted in shortening of the planned first irradiation sequence in 2 patients (1 in each group) and an unplanned treatment break in 11 patients (4 in the RT group and 7 in the RT‐CT group). Grade 2 and 3 acute reactions (RTOG) were observed in 43% and 54% of patients, respectively. Among all Grade 3 reactions, 32% occurred in the RT group and 68% in the RT‐CT group. In patients receiving RT‐CT, Grade 2–3 leukopenia was observed in 25% of patients, Grade 2–3 fatigue was observed in 58% of patients, and Grade 2 cardiac toxicity related to 5‐FU occurred in 1 patient. At 5 years, the overall survival was 54% (49% and 59% for the RT and RT‐CT groups, respectively, P = 0.28), and the actuarial local control rate was 78.5% (73% and 83% for the RT and RT‐CT groups, respectively, P = 0.36). Five patients presented with Grade 3–4 late complications, all of them in the RT‐CT group. CONCLUSIONS The current series confirms the feasibility of sphincter‐conserving treatment for elderly patients who present with anal carcinoma. Rates of acute or late complications appeared similar to those observed in younger patients, and the oncologic results were at least as favorable as those commonly reported. Cancer 1999;85:26–31. © 1999 American Cancer Society.