title: Chemoradiotherapy of anal carcinoma: survival and recurrence in an unselected national cohort.
abstract: OBJECTIVE
  To evaluate treatment results, elucidate whether national guidelines were followed, and identify areas demanding further treatment optimization.
  
  
  METHODS
  Between July 2000 and June 2007, 328 patients were treated with curatively intended chemoradiotherapy (CRT) for nonmetastatic squamous cell carcinoma of the anal region, according to national treatment guidelines based on tumor stage.
  
  
  RESULTS
  Complete response after CRT was obtained in 87% of patients, rising to 93% after salvage surgery. Chemotherapy, elective irradiation of the groin and salvage surgery were performed to a lesser extent in elderly patients, mainly because of frailty and comorbidity. Recurrence occurred in 24% of the patients, resulting in a 3- and 5-year recurrence-free survival (RFS) of 79% and 74%, respectively. Locoregional recurrences dominated, most commonly in the primary tumor site. Recurrence was treated with curative intent in 45% of the cases. The 3- and 5-year overall survival were 79% and 66%, and cancer-specific survival (CSS) were 84% and 75%, respectively. The risk of adverse outcome increased significantly with more locally advanced tumors and for male gender in multivariable analyses for RFS and CSS.
  
  
  CONCLUSIONS
  The treatment results are in accordance with similar cohorts. The primary treatment control rate was high, but there was a significant risk of locoregional recurrence in advanced tumors. The loyalty to national guidelines was broad, although individual adjustments occurred. However, caution to avoid toxicity must not lead to inadequate treatment. Male gender seems to have inferior outcome.
authors.affiliation: Department of Oncology, University Hospital of Northern Norway, Tromsø, Norway. anne.gry.bentzen@unn.no
authors.forename: Anne Gry
authors.initials: AG
authors.lastname: Bentzen
authors.forename: Marianne G
authors.initials: MG
authors.lastname: Guren
authors.forename: Eva H
authors.initials: EH
authors.lastname: Wanderås
authors.forename: Gunilla
authors.initials: G
authors.lastname: Frykholm
authors.forename: Kjell M
authors.initials: KM
authors.lastname: Tveit
authors.forename: Tom
authors.initials: T
authors.lastname: Wilsgaard
authors.forename: Olav
authors.initials: O
authors.lastname: Dahl
authors.forename: Lise
authors.initials: L
authors.lastname: Balteskard
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D003125:Colostomy / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006119:Groin; D019983:Guideline Adherence; D006801:Humans; D015182:Lymphatic Irradiation / Q000379:methods; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D018365:Neoplasm, Residual; D009664:Norway / Q000453:epidemiology; D011879:Radiotherapy Dosage; D012074:Remission Induction; D016879:Salvage Therapy / Q000379:methods; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D016685:Mitomycin; D002945:Cisplatin; D005472:Fluorouracil