Mitomycin-C- or cisplatin-based chemoradiotherapy for anal canal carcinoma: long-term results.
OBJECTIVE
To evaluate the long-term efficacy of concurrent radiotherapy with mitomycin-C (MMC)-based or cisplatin (CP)-based combinations in a cohort of patients with locally advanced anal canal carcinoma.


METHODS
Between 1988 and 2000, 179 patients with locally advanced anal canal carcinoma were treated at the Instituto Nacional de Câncer with two cycles of chemotherapy during Weeks 1 and 5 of radiotherapy. 5-Fluorouracil (750 mg/m(2) 120-hour infusion or 1,000 mg/m(2) 96-hour infusion) plus CP (100 mg/m(2)) on the first day of each cycle or MMC (10-15 mg/m(2)) on the first day of Cycle 1 was administered concurrent with radiotherapy (total dose, 55-59.4 Gy). Of the 179 patients, 60% were included from a randomized trial initiated at the Instituto Nacional de Câncer in 1991 that compared concurrent chemoradiotherapy with MMC vs. CP.


RESULTS
The median follow-up for the whole chemoradiotherapy group was 83 months. The median patient age was 58 years, 57% had Stage T3-T4 tumors, and 35% had N-positive disease. The 5-year cumulative colostomy rate was not significantly different between the CP group (22%) and MMC group (29%; p = .28). The actuarial 10-year overall survival and disease-free survival rate for the CP group was 54% and 49% and for the MMC group was 52% and 53%, respectively (p = .32 and p = .92, respectively). On multivariate analysis, male gender (p = .042) and advanced Stage T3-T4 disease (p <.0001) were statistically significant for worse disease-free survival. Stage T3-T4 (p = .039) and N+ (p = .039) disease remained independently significant for overall survival.


CONCLUSIONS
Long-term follow-up has confirmed the good results of chemoradiotherapy with CP plus 5-fluorouracil, which seem to provide results equivalent to those with MMC plus 5-fluorouracil.
Olivatto
Luis O
LO
Division of Clinical Oncology, Hospital do Câncer, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. olivatto@inca.gov.br
Cabral
Vânia
V
Rosa
Arthur
A
Bezerra
Marcos
M
Santarem
Erick
E
Fassizoli
Ana
A
Castro
Leonaldson
L
Simões
José Humberto
JH
Small
Isabele A
IA
Ferreira
Carlos Gil
CG
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003125:Colostomy / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016879:Salvage Therapy; D012737:Sex Factors
D016685:Mitomycin; D002945:Cisplatin