NCI CANCERLIT^® Search: Anal Cancer - September 2001

Last Modified: November 1, 2001

High-dose radiation therapy and neoadjuvant plus concomitant chemotherapy with 5-fluorouracil and cisplatin in patients with locally advanced squamous-cell anal canal cancer: final results of a phase II study.
What is the prevalence of symptomatic or asymptomatic femoral head osteonecrosis in patients previously treated with chemoradiation? A magnetic resonance study of anal cancer patients.
Anal duct carcinoma: report of case and a survey of the experience of the American Osteopathic College of Proctology.

CancerMail from the National Cancer Institute

1
UI - 21230836
AU - Peiffert D; Giovannini M; Ducreux M; Michel P; Francois E; Lemanski C; Mirabel X; Cvitkovic F; Luporsi E; Conroy T; Gerard JP; Digestive Tumours Group of the French 'Federation Nationale des Centres de Lutte Contre le Cancer'
TI - High-dose radiation therapy and neoadjuvant plus concomitant chemotherapy with 5-fluorouracil and cisplatin in patients with locally advanced squamous-cell anal canal cancer: final results of a phase II study.
SO - Ann Oncol 2001 Mar;12(3):397-404
AD - Centre Alexis Vautrin, Nancy, France. d.peiffert@nancy.fnclcc.fr
PURPOSE: To analyse toxicity and response to a new scheme of neoadjuvant chemotherapy (CT) and concomitant radiochemotherapy (RT-CT) for locally advanced anal canal squamous-cell carcinoma (ACC). PATIENTS AND METHODS: Eighty patients with an ACC > 40 mm and/or with lymph node involvement were included (1 T1, 52 T2, 14 T3, 13 T4, 18 N0, 30 N1, 32 N2-N3). Two cycles of 5-fluorouracil (5-FU) and CDDP were delivered as neoadjuvant CT and two during RT-CT. Pelvic (+/- inguinal) RT delivered 45 Gy in 25 fractions of 1.8 Gy. Involved fields were boosted after a one to two month gap (15-20 Gy). The median follow-up was 29 months. RESULTS: One patient died of a pulmonary embolism on day 4. All patients received the entire treatment, with reduced 5-FU doses in 27% of the cases because of acute toxicity. Sixty-four grade 3 and five grade 4 toxicities were observed. No toxic death occurred. Complete response (CR) and partial response (PR) rates were, respectively, 10% and 51% after neoadjuvant CT, 67% and 28% after RT-CT and 93% and 5% after treatment completion (including 4 abdomino-perineal resections). The three-year actuarial overall, tumour-specific, colostomy-free, relapse-free, disease-free and event-free survivals were 86%, 88%, 73%, 70%, 67% and 63%, respectively. CONCLUSIONS: Tolerance was good. After neoadjuvant CT, most of the patients were objective responders. After treatment completion, all but five achieved CR. The long-term results confirm the durability of local control and low toxicity on the sphincter. An ongoing phase III intergroup trial analyses the impact of neoadjuvant CT, and the benefit of a high-dose boost irradiation, on local control and colostomy-free survival.

2
UI - 21268252
AU - Dzik-Jurasz AS; Brooker S; Husband JE; Tait D
TI - What is the prevalence of symptomatic or asymptomatic femoral head osteonecrosis in patients previously treated with chemoradiation? A magnetic resonance study of anal cancer patients.
SO - Clin Oncol (R Coll Radiol) 2001;13(2):130-4
AD - Royal Marsden Hospital NHS Trust, Sutton, UK. andrzej@icr.ac.uk
It is generally assumed that femoral head osteonecrosis (FHO) is a serious but rare complication of pelvic radiotherapy. A review of the literature carried out by the authors indicates a prevalence of 4/763 (95% confidence interval 0.1%-1.3%). A recent publication has suggested that the prevalence of symptomatic FHO may be much greater than previously assumed as a result of sensitization of bone to radiation by concomitant treatment with chemotherapy. Magnetic resonance imaging (MRI) is currently the most sensitive modality for detecting and confirming symptomatic or asymptomatic FHO of any aetiology. The aim of this study therefore was to assess the prevalence of symptomatic and asymptomatic FHO in patients previously treated for anal cancer by chemoradiation (CRT). The hips of 34 currently disease-free individuals (11 men and 23 women; median age 67 years, range 32-86) were scanned using a coronal T1-weighted sequence. The images were assessed for evidence of FHO. The median time of scanning after the end of CRT was 35 months (range 6-107). No cases (0/34) of symptomatic or asymptomatic FHO were detected in these patients. Given the established sensitivity of MRI in the detection of FHO, it is concluded that changes indicative of osteonecrosis were uncommon after CRT in the current cohort of patients. Recent evidence from the literature suggests, however, that elderly females are at greatest risk of developing FHO after CRT.

3
UI - 21418659
AU - Biggs RL; Lucha PA Jr; Stoll PM
TI - Anal duct carcinoma: report of case and a survey of the experience of the American Osteopathic College of Proctology.
SO - J Am Osteopath Assoc 2001 Aug;101(8):450-3
AD - Department of General Surgery, Naval Medical Center, Portsmouth, Va., USA.
Anal duct carcinoma, also known as anal gland carcinoma or adenocarcinoma of the anal canal, is an unusual anal cancer that accounts for approximately 0.1% of all gastrointestinal cancers. Delays in diagnosis most likely account for the poor prognosis associated with this cancer. Presenting symptoms often mimic those of more common benign anorectal pathologic processes. Multimodality treatment that includes surgery, chemotherapy, and radiation therapy is often recommended. The authors describe a typical case of anal duct carcinoma and its management. They also discuss the findings of a survey of the combined experience of members of the American Osteopathic College of Proctology and review the literature.