title: Time-dose considerations in the treatment of anal cancer.
abstract: OBJECTIVE
  To analyze the impact of patient and treatment parameters in concurrent chemoradiation treatment for anal carcinoma.
  
  
  METHODS
  Retrospective review of 50 MO anal cancer patients treated from 1984-1994. Most patients received concurrent 5-FU, mitomycin, and radiation. Local control and disease-free/overall survival were determined and analyzed according to patient and treatment parameters.
  
  
  RESULTS
  With 43 month median follow-up, projected overall survival is 66% at 5 and 8 years. Disease-free survival is 67% at 5 years and 59% at 8 years. Local control is 70% at 5 and 8 years. Doses of > or =54 Gy are associated with improved 5-year survival (84 vs. 47%, p = 0.02), disease-free survival (74 v. 56%, p = 0.09), and local control (77 vs. 61%, p = 0.04). Although local control, disease-free survival, and overall survival were improved in patients whose overall treatment time was <40 days, this was not statistically significant. Outcome in the four patients with pretreatment hemoglobin (Hgb) <10 appeared worse with 3-year overall survival 50 vs. 68% (p = 0.07), disease-free survival 0 vs. 67% (p = 0.11), and local control 0 vs. 74% (p = 0.05). Projected 5-year overall survival, relapse-free survival, and local control in 4 HIV(+) patients is 0, 75, and 75%. Multivariate analysis reveals that dose (p = 0.02) and Hgb (p = 0.05) independently affect local control, dose (p = 0.02) affects disease-free survival, and dose (p = 0.01), Hgb (p = 0.03), T-stage (p = 0.03), and HIV-status (0.07) independently influence overall survival.
  
  
  CONCLUSIONS
  Radiation doses of > or =54 Gy are associated with significantly improved survival and local control in anal cancer patients treated with chemoradiation. Overall treatment times of less than 40 days are associated with a trend towards improved outcome, but this is not significant. Pretreatment hemoglobin <10 is associated with worse treatment outcome. Survival of HIV (+) patient is poor, but the majority of such patients in this series died of intercurrent disease with their anal carcinomas controlled by chemoradiation.
authors.affiliation: Department of Radiation Oncology, Boston University Medical Center/School of Medicine, MA 02118-2393, USA.
authors.forename: E C
authors.initials: EC
authors.lastname: Constantinou
authors.forename: W
authors.initials: W
authors.lastname: Daly
authors.forename: C Y
authors.initials: CY
authors.lastname: Fung
authors.forename: C G
authors.initials: CG
authors.lastname: Willett
authors.forename: D S
authors.initials: DS
authors.lastname: Kaufman
authors.forename: T F
authors.initials: TF
authors.lastname: DeLaney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D015658:HIV Infections / Q000150:complications; D006441:Hemoglobin A / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000970:Antineoplastic Agents; D016685:Mitomycin; D006441:Hemoglobin A; D005472:Fluorouracil