title: Predictive factors for early and late local toxicities in anal cancer treated by radiotherapy in combination with or without chemotherapy.
abstract: BACKGROUND
  The treatment of anal cancer is based on concomitant radiotherapy and chemotherapy and is associated with a nonnegligible rate of local severe toxicities that can strongly impair the quality of life.
  
  
  OBJECTIVE
  A retrospective analysis was performed to screen the following factors as potential predictive factors for local skin and digestive toxicities, and as potential prognostic factors for cumulative colostomy incidence: sex, age, tumor size, clinical T and N stage, circumferential extension, invasion of anal margin, HIV status, type of chemotherapy, and type of radiotherapy and dose delivered.
  
  
  METHODS
  One hundred five patients in our database treated between January 2000 and February 2010 met the eligibility criteria.
  
  
  RESULTS
  Median follow-up was 54.1 months (range, 1-133). Early and late severe local toxicities occurred in 33 patients (31.4%) and 18 patients (17.1%). The 5-year cumulative rate of colostomy was 26.6%. Predictive factors for local severe early toxicities were as follows: clinical stage III/IV (p = 0.01), no brachytherapy boost (p = 0.003), and use of chemotherapy (p = 0.01). Only brachytherapy retained its independence in multivariate analysis (OR = 4.8 (1.4-16.3), p = 0.01). Human immunodeficiency virus positivity (p = 0.04) was the only predictive factor for late toxicities in univariate analysis; it was linked independently to the occurrence of ulcer (OR = 0.1 (0.01-0.66), p = 0.01). Tumor size ≥4 cm (p < 0.001) and occurrence of grade 2 to 3 ulcers (p < 0.001) were correlated with greater cumulative colostomy incidence.
  
  
  CONCLUSIONS
  In this cohort, nonuse of brachytherapy was an independent predictive factor for local acute toxicity. Human immunodeficiency virus positivity was the only predictive factor for local late toxicities and strongly influenced the onset of ulcer.
authors.affiliation: 1 Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France 2 Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France 3 Department of Medical Statistics, Centre Antoine-Lacassagne, Nice, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Doyen
authors.forename: Karen
authors.initials: K
authors.lastname: Benezery
authors.forename: Philippe
authors.initials: P
authors.lastname: Follana
authors.forename: Cécile
authors.initials: C
authors.lastname: Ortholan
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Gérard
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Hannoun-Levi
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Gal
authors.forename: Eric
authors.initials: E
authors.lastname: Francois
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000473:pathology / Q000628:therapy*; D001918:Brachytherapy / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003125:Colostomy; D003875:Drug Eruptions / Q000209:etiology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009336:Necrosis / Q000139:chemically induced; D011349:Proctitis / Q000209:etiology; D011832:Radiation Injuries / Q000209:etiology*; D011855:Radiodermatitis / Q000209:etiology; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D012883:Skin Ulcer / Q000209:etiology; D015996:Survival Rate; D013997:Time Factors
chemical_list: D016685:Mitomycin; D002945:Cisplatin; D005472:Fluorouracil