title: Long-term results of weekly/daily cisplatin-based chemoradiation for locally advanced squamous cell carcinoma of the anal canal.
abstract: BACKGROUND
  Weekly or daily cisplatin and 5-fluorouracil (5-FU)-based chemoradiation was evaluated for patients with locally advanced squamous cell carcinoma (SCC) of the anal canal treated at a single institution over a 20-year period.
  
  
  METHODS
  A retrospective, single-institution analysis was conducted of patients receiving concurrent 5-FU/cisplatin and radiotherapy for locally advanced SCC from 1989 to 2009. Endpoints included clinical complete response rate, local recurrence rate, colostomy-free survival, disease-free survival (DFS), overall survival, and treatment-related toxicity.
  
  
  RESULTS
  A total of 197 patients were evaluable. The majority had American Joint Committee on Cancer stage II (41%) or stage III (46%) disease; most were T2 (44%) or T3 (27%); bulky nodal disease (N2-N3) was noted in 24% of patients. Patients received weekly (20 mg/m2) or daily (4 mg/m2) cisplatin during radiotherapy. Median radiation dose was 55 Gy. Clinical complete response was observed in 185 patients (94%). After a median follow-up of 8.6 years, local recurrence rate was 11%. Sixteen patients (8%) developed distant metastases. The 5-year DFS was 81%, the 5-year overall survival was 86%, and the 5-year colostomy-free survival was 88%. By univariate analysis, N-stage was a poor prognostic indicator for 5-year DFS (P = .02, 95% confidence interval = 1.17-2.01) and distant metastases (P = .046, 95% confidence interval = 1.09-2.13). Increased T-stage correlated with the necessity for salvage surgery (P = .01).
  
  
  CONCLUSIONS
  The combination of weekly/daily cisplatin and 5-FU-based chemotherapy with concurrent radiotherapy is an effective regimen, and our long-term results indicate that cisplatin is an alternative to mitomycin C and may be considered for the treatment of locally advanced SCC of the anal canal.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Cathy
authors.initials: C
authors.lastname: Eng
authors.forename: George J
authors.initials: GJ
authors.lastname: Chang
authors.forename: Y Nancy
authors.initials: YN
authors.lastname: You
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.forename: Yan
authors.initials: Y
authors.lastname: Xing
authors.forename: Marc
authors.initials: M
authors.lastname: Delclos
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rodriguez-Bigas
authors.forename: John
authors.initials: J
authors.lastname: Skibber
authors.forename: Aki
authors.initials: A
authors.lastname: Ohinata
authors.forename: Spencer
authors.initials: S
authors.lastname: Gould
authors.forename: Jonathan
authors.initials: J
authors.lastname: Phillips
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D000970:Antineoplastic Agents / Q000008:administration & dosage; 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*; D003125:Colostomy / Q000706:statistics & numerical data; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: anal carcinoma; chemoradiation; cisplatin; combined therapy; outcomes