Intracavitary afterloading boost in anal canal carcinoma. Results, function and quality of life.
BACKGROUND
First clinical data on a new intracavitary afterloading boost method for anal canal carcinoma is reported.


METHODS
20 consecutive patients (T1 5%, T2 70%, T3 20%, T4 5%; N0 75%, N1 10%, N2 15%; all M0) treated with external beam pelvic radiotherapy (median dose 56 Gy, range 46-64 Gy), simultaneous 5-FU and mitomycin (in 75%) and an intracavitary afterloading boost (one or two fractions of 5 Gy at 5 mm depth) were analyzed after a mean +/- SD follow-up for living patients of 4.4 +/- 2.1 years. Quality of Life (QoL) and anorectal manometry parameters were assessed in ten colostomy-free survivors.


RESULTS
Overall, recurrence-free and colostomy-free survival at 5 years were 84%, 79% and 69%, respectively. No death was tumor-related. The only local failure was successfully salvaged by local excision. All three colostomies were performed for toxicity. Resting pressure and maximum squeeze pressure of the anal sphincter were reduced by 51% and 71%, as compared with control subjects, but quality of life was similar compared to healthy volunteers.


CONCLUSIONS
The described regimen is highly effective but associated with increased toxicity.
Vordermark
D
D
Klinik für Strahlentherapie, Universität Würzburg, Germany. vordermark@strahlentherapie.uni-wuerzburg.de
Flentje
M
M
Sailer
M
M
Kölbl
O
O
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D001918:Brachytherapy; D003125:Colostomy; D003131:Combined Modality Therapy; D005242:Fecal Incontinence; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009367:Neoplasm Staging; D011788:Quality of Life; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D016685:Mitomycin; D005472:Fluorouracil