title: Anal carcinoma - Survival and recurrence in a large cohort of patients treated according to Nordic guidelines.
abstract: OBJECTIVE
  To evaluate treatment outcome in a large population-based cohort of patients with anal cancer treated according to Nordic guidelines.
  
  
  METHODS
  Clinical data were collected on 1266 patients with anal squamous cell carcinoma diagnosed from 2000 to 2007 in Sweden, Norway and Denmark. 886 of the patients received radiotherapy 54-64Gy with or without chemotherapy (5-fluorouracil plus cisplatin or mitomycin) according to different protocols, stratified by tumor stage.
  
  
  RESULTS
  High age, male gender, large primary tumor, lymph node metastases, distant metastases, poor performance status, and non-inclusion into a protocol were all independent factors associated with worse outcome. Among patients treated according to any of the protocols, the 3-year recurrence-free survival ranged from 63% to 76%, with locoregional recurrences in 17% and distant metastases in 11% of patients. The highest rate of inguinal recurrence (11%) was seen in patients with small primary tumors, treated without inguinal irradiation.
  
  
  CONCLUSIONS
  Good treatment efficacy was obtained with Nordic, widely implemented, guidelines for treatment of anal cancer. Inguinal prophylactic irradiation should be recommended also for small primary tumors.
authors.affiliation: Department of Oncology, Skåne University Hospital, Lund, Sweden.
authors.forename: Otilia
authors.initials: O
authors.lastname: Leon
authors.affiliation: Department of Oncology, Oslo University Hospital, Norway.
authors.forename: Marianne
authors.initials: M
authors.lastname: Guren
authors.affiliation: Regional Cancer Center South, Sweden.
authors.forename: Oskar
authors.initials: O
authors.lastname: Hagberg
authors.affiliation: Department of Oncology, Uppsala Academic Hospital, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.affiliation: Department of Oncology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Olav
authors.initials: O
authors.lastname: Dahl
authors.affiliation: Department of Oncology, Herlev Hospital, Denmark.
authors.forename: Hanne
authors.initials: H
authors.lastname: Havsteen
authors.affiliation: Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Gisela
authors.initials: G
authors.lastname: Naucler
authors.affiliation: Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Svensson
authors.affiliation: Department of Oncology, Oslo University Hospital, Norway.
authors.forename: Kjell Magne
authors.initials: KM
authors.lastname: Tveit
authors.affiliation: Department of Oncology, Vejle Hospital, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Jakobsen
authors.affiliation: Department of Oncology, Odense Hospital, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Pfeiffer
authors.affiliation: Department of Oncology, Oslo University Hospital, Norway.
authors.forename: Eva
authors.initials: E
authors.lastname: Wanderås
authors.affiliation: Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Tor
authors.initials: T
authors.lastname: Ekman
authors.affiliation: Department of Oncology, Norrland University Hospital, Umeå, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Lindh
authors.affiliation: Centre for Clinical Documentation and Evaluation, Northern Regional Health Authority, Tromsö, Norway.
authors.forename: Lise
authors.initials: L
authors.lastname: Balteskard
authors.affiliation: Department of Oncology, St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Frykholm
authors.affiliation: Department of Oncology, Skåne University Hospital, Lund, Sweden. Electronic address: Anders.Johnsson@skane.se.
authors.forename: Anders
authors.initials: A
authors.lastname: Johnsson
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods; D002945:Cisplatin / Q000627:therapeutic use; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009664:Norway / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012737:Sex Factors; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D016685:Mitomycin; D002945:Cisplatin; D005472:Fluorouracil
keywords: Anal cancer; Chemoradiotherapy; Radiotherapy