title: Chemo-radiation with or without mandatory split in anal carcinoma: experiences of two institutions and review of the literature.
abstract: BACKGROUND
  The split-course schedule of chemo-radiation for anal cancer is controversial.
  
  
  METHODS
  Eighty-four patients with invasive anal cancer treated with definitive external beam radiotherapy (RT) with a mandatory split of 12 days (52 patients, Montreal, Canada) or without an intended split (32 patients, Zurich, Switzerland) were reviewed. Total RT doses were 52 Gy (Montreal) or 59.4 Gy (Zurich) given concurrently with 5-FU/MMC.
  
  
  RESULTS
  After a mean follow-up of 40 +/- 27 months, overall survival and local tumor control at 5 years were 57% and 78% (Zurich) compared to 67% and 82% (Montreal), respectively. Split duration of patients with or without local relapse was 15 +/- 7 d vs. 14 +/- 7 d (Montreal, NS) and 11 +/- 11 d vs. 5 +/- 7 d (Zurich; P < 0.001). Patients from Zurich with prolonged treatment interruption (> or = 7 d) had impaired cancer-specific survival compared with patients with only minor interruption (<7 d) (P = 0.06). Bowel toxicity was associated with prolonged RT (P = 0.03) duration as well as increased relapse probability (P = 0.05). Skin toxicity correlated with institution and was found in 79% (Montreal) and 28% (Zurich) (P < 0.0001).
  
  
  CONCLUSIONS
  The study design did not allow demonstrating a clear difference in efficacy between the treatment regimens with or without short mandatory split. Cause-specific outcome appears to be impaired by unplanned prolonged interruption.
authors.affiliation: Department of Radiation Oncology, Zurich University Hospital, Zurich, Switzerland. chris.oehler@bluewin.ch
authors.forename: Christoph
authors.initials: C
authors.lastname: Oehler
authors.forename: Sawyna
authors.initials: S
authors.lastname: Provencher
authors.forename: David
authors.initials: D
authors.lastname: Donath
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Bahary
authors.forename: Urs M
authors.initials: UM
authors.lastname: Lütolf
authors.forename: I Frank
authors.initials: IF
authors.lastname: Ciernik
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D012196:Review Literature as Topic; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D016685:Mitomycin; D002945:Cisplatin; D005472:Fluorouracil
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