Mitomycin-C– or Cisplatin-Based Chemoradiotherapy for Anal Canal Carcinoma: Long-Term Results

• Published in: International journal of radiation oncology, biology, physics Vol. 79; no. 2; pp. 490 - 495
• Main Authors: Olivatto, Luis O., M.Sc, Cabral, Vânia, M.D, Rosa, Arthur, M.D, Bezerra, Marcos, M.D, Santarem, Erick, M.D, Fassizoli, Ana, M.D, Castro, Leonaldson, Ph.D, Simões, José Humberto, M.S, Small, Isabele A., M.S, Ferreira, Carlos Gil, Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2011; Elsevier
• Subjects: Adult; Aged; Anal canal carcinoma; Analysis of Variance; ANTI-INFECTIVE AGENTS; ANTIBIOTICS; ANTIMITOTIC DRUGS; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; ANTINEOPLASTIC DRUGS; Anus Neoplasms - drug therapy; Anus Neoplasms - pathology; Anus Neoplasms - radiotherapy; Anus Neoplasms - surgery; AZINES; Biological and medical sciences; BODY; CARCINOMAS; Chemoradiotherapy; Chemotherapy; Cisplatin; Cisplatin - administration & dosage; Colostomy - utilization; Combined Modality Therapy; COMBINED THERAPY; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); DIGESTIVE SYSTEM; DISEASES; DRUGS; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; GASTROINTESTINAL TRACT; Hematology, Oncology and Palliative Medicine; HETEROCYCLIC COMPOUNDS; Humans; HYDROXY COMPOUNDS; INTESTINES; LARGE INTESTINE; Male; Medical sciences; MEDICINE; Middle Aged; MITOMYCIN; Mitomycin - administration & dosage; Mitomycin-C; NEOPLASMS; ORGANIC COMPOUNDS; ORGANIC NITROGEN COMPOUNDS; ORGANS; Pharmacology. Drug treatments; PYRIMIDINES; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiotherapy Dosage; Randomized Controlled Trials as Topic; RECTUM; Retrospective Studies; Salvage Therapy; Sex Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; THERAPY; Tumors; URACILS; Mitomycin-C; Chemoradiotherapy; Cisplatin; Anal canal carcinoma; Antineoplastic agent; Mitomycin; Anus carcinoma; Malignant tumor; Radiotherapy; Anal canal; Alkylating agent; Antibiotic; Chemotherapy; Treatment; Digestive diseases; Intestinal disease; Anorectal disease; Cancer; Platinum II Complexes
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2009.11.057

Purpose To evaluate the long-term efficacy of concurrent radiotherapy with mitomycin-C (MMC)–based or cisplatin (CP)-based combinations in a cohort of patients with locally advanced anal canal carcinoma. Methods and Materials Between 1988 and 2000, 179 patients with locally advanced anal canal carcinoma were treated at the Instituto Nacional de Câncer with two cycles of chemotherapy during Weeks 1 and 5 of radiotherapy. 5-Fluorouracil (750 mg/m2 120-hour infusion or 1,000 mg/m2 96-hour infusion) plus CP (100 mg/m2 ) on the first day of each cycle or MMC (10–15 mg/m2 ) on the first day of Cycle 1 was administered concurrent with radiotherapy (total dose, 55–59.4 Gy). Of the 179 patients, 60% were included from a randomized trial initiated at the Instituto Nacional de Câncer in 1991 that compared concurrent chemoradiotherapy with MMC vs. CP. Results The median follow-up for the whole chemoradiotherapy group was 83 months. The median patient age was 58 years, 57% had Stage T3-T4 tumors, and 35% had N-positive disease. The 5-year cumulative colostomy rate was not significantly different between the CP group (22%) and MMC group (29%; p = .28). The actuarial 10-year overall survival and disease-free survival rate for the CP group was 54% and 49% and for the MMC group was 52% and 53%, respectively ( p = .32 and p = .92, respectively). On multivariate analysis, male gender ( p = .042) and advanced Stage T3-T4 disease ( p <.0001) were statistically significant for worse disease-free survival. Stage T3-T4 ( p = .039) and N+ ( p = .039) disease remained independently significant for overall survival. Conclusion Long-term follow-up has confirmed the good results of chemoradiotherapy with CP plus 5-fluorouracil, which seem to provide results equivalent to those with MMC plus 5-fluorouracil.