title: Patterns of failure and outcome in patients with carcinoma of the anal margin.
abstract: BACKGROUND
  To evaluate the outcome of patients with carcinoma of anal margin in terms of recurrence, survival, and radiation toxicity.
  
  
  METHODS
  A series of 45 consecutive patients, with anal margin carcinoma treated between 1983 and 2006 with curative intent at two institutions, was retrospectively analyzed. A surgical excision (close or positive surgical margin in 22 out of 29 patients) was realized before radiotherapy (RT). RT consisted of definitive external beam RT (EBRT) in 36 patients, brachytherapy (BT) alone in two patients, and both BT and EBRT in seven patients. The median total radiation dose was 59.4 Gy (range, 30-74 Gy).
  
  
  RESULTS
  The 5-year locoregional control (LRC) rate was 78% [95% confidence interval (CI), 64-93%]. The 5-year disease-specific survival (DSS) and overall survival (OS) rates were respectively 86% (95% CI, 72-99%) and 55% (95% CI, 44-66%). The overall anal conservation rate was 80% for the whole series. There was no significant association between local recurrence and patient age, histological grade, tumor size, T stage, overall treatment time, RT dose, or chemotherapy. Long-term side effects were observed in 15 patients (33%). Only three patients developed grade 3-4 late toxicity (CTCAE/NCI v3.0). Significant relationship was found between dose, and complication rate (48% for dose >or=59.4 Gy versus 8% for dose < 59.4 Gy; P = 0.03).
  
  
  CONCLUSIONS
  We conclude that definitive RT and/or BT yield a good local control and disease-specific survival comparable with published data. This study suggests that radiation dose over 59.4 Gy seems to increase treatment-related morbidity.
authors.affiliation: Department of Radiation Oncology, Hôpital de Sion, Grand-Champsec 81, CH-1051, Sion, Switzerland. kaouthar.khanfir@rsv-gnw.ch
authors.forename: Kaouthar
authors.initials: K
authors.lastname: Khanfir
authors.forename: Mahmut
authors.initials: M
authors.lastname: Ozsahin
authors.forename: Sabine
authors.initials: S
authors.lastname: Bieri
authors.forename: Christiano
authors.initials: C
authors.lastname: Cavuto
authors.forename: René O
authors.initials: RO
authors.lastname: Mirimanoff
authors.forename: Abderrahim
authors.initials: A
authors.lastname: Zouhair
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D001005:Anus Neoplasms / Q000473:pathology / Q000628:therapy*; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome