title: Treatment of T3 and T4 anal carcinoma with combined chemoradiation and interstitial 192Ir implantation: a 10-year experience.
abstract: OBJECTIVE
  To report our experience in treating T3 and T4 anal carcinoma with combined external beam (EBRT) and chemotherapy, followed by interstitial (192)Ir implant boost.
  
  
  METHODS
  From 1990 to 2000, 31 patients with T3 and T4 anal carcinoma were treated with: 30 Gy EBRT (2 Gy fractions, 5 days/week) + 5-fluorouracil + mitomycin-C. Median implant dose was 31.3 Gy at 0.5 cm, delivered at a mean rate of 0.52 Gy/h.
  
  
  RESULTS
  Six patients had local persistence and 4 eventually developed local-regional recurrence. Eight underwent abdomino-perineal resection (APR). With the addition of APR in selected cases, the ultimate local-regional control after initial treatment was 84%. Distant metastases occurred in 10. Of the initial cohort, 55% is still alive and NED. Eight had radiation proctitis and 7 developed postimplant ulceration. Only 1 required surgical intervention.
  
  
  CONCLUSIONS
  Treatment of T3 and T4 anal cancer with combined chemotherapy and EBRT, followed by interstitial implant results in an ultimate local-regional control of 84%, after the inclusion of selected APR. It is well tolerated, with acceptable toxicity.
authors.affiliation: Department of Radiation Oncology, Southern California Permanente Group, 4950 Sunset Boulevard, 2nd Floor, Los Angeles, CA 90027, USA. juliemhwang@hotmail.com
authors.forename: Julie M
authors.initials: JM
authors.lastname: Hwang
authors.forename: Aroor R
authors.initials: AR
authors.lastname: Rao
authors.forename: Harry A
authors.initials: HA
authors.lastname: Cosmatos
authors.forename: Ricardo
authors.initials: R
authors.lastname: Wang
authors.forename: John S
authors.initials: JS
authors.lastname: Kaptein
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kagan
authors.forename: Jim Y
authors.initials: JY
authors.lastname: Hsiang
authors.forename: Michael
authors.initials: M
authors.lastname: Tome
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000532:radiotherapy*; D001918:Brachytherapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D007496:Iridium Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*
chemical_list: D000903:Antibiotics, Antineoplastic; D007496:Iridium Radioisotopes; D016685:Mitomycin; D005472:Fluorouracil