title: Long-term outcome after combined radiochemotherapy for anal cancer - retrospective analysis of efficacy, prognostic factors, and toxicity.
abstract: BACKGROUND
  This retrospective study evaluated the efficacy, prognostic factors, and toxicity of combined radiochemotherapy for anal cancer.
  
  
  METHODS
  Data of 90 patients treated with radiochemotherapy between 1990 and 2006 were analyzed. Mean follow-up was 30 months (range: 2-129 months). Endpoints were disease-specific survival, local control, freedom from metastasis, and colostomy-free survival. Tumor stage, nodal status, age, sex, tumor site, tumor resection, and radiation dose were analyzed for prognostic value. Acute toxicity was scored according to the RTOG/EORTC scale, late toxicity according to the LENT/ SOMA scale.
  
  
  RESULTS
  Disease-specific survival was 86%, local control 79%, freedom from metastasis 92%, and colostomy-free survival 83%. Higher T category was associated with inferior prognosis for colostomy-free survival (p = 0.000), male sex for local control (p = 0.004) and diseasespecific survival (p = 0.002), and tumor site at the anal margin for local control (p = 0.03). 4 of 7 patients with recurrent anal margin tumors had human papillomavirus (HPV)-related disease. 49% of patients suffered from > or = grade 3 acute toxicity. 3 patients had late toxicity of grade 3 concerning sphincter control.
  
  
  CONCLUSIONS
  Combined radiochemotherapy for anal cancer is a highly effective therapy with pronounced acute and minor late toxicity. In the case of higher T stage, male sex, and cancer at the anal margin, treatment intensification should be considered.
authors.affiliation: Department of Radiation Oncology, University Medical Center Mannheim, Germany. sabine.mai@radonk.ma.uni-heidelberg.de
authors.forename: Sabine K
authors.initials: SK
authors.lastname: Mai
authors.forename: Grit
authors.initials: G
authors.lastname: Welzel
authors.forename: Brigitte
authors.initials: B
authors.lastname: Hermann
authors.forename: Markus
authors.initials: M
authors.lastname: Bohrer
authors.forename: Frederik
authors.initials: F
authors.lastname: Wenz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001005:Anus Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy / Q000401:mortality; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control*; D015995:Prevalence; D011379:Prognosis; D011878:Radiotherapy / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome