title: Chemoradiotherapy with Brachytherapy or Electron Therapy Boost for Locally Advanced Squamous Cell Carcinoma of the Anus-Reducing the Colostomy Rate.
abstract: OBJECTIVE
  The aim of this study is to determine overall survival, disease-specific survival and stoma-free survival after treatment of squamous cell carcinoma of the anus with chemoradiotherapy followed by brachytherapy or electron boost in a recent cohort of patients.
  
  
  METHODS
  Fifty-two patients (median age 62 years) were treated with radical chemoradiotherapy (mitomycin C, infusional 5-fluorouracil concurrently with conformal radical radiotherapy 45 Gy in 25 fractions over 5 weeks) followed by a radiotherapy boost between 1 December 2000 and 30 April 2011. Follow-up was to 30 November 2014. Thirty-six patients received a boost (15-20 Gy) over 2 days with192Ir needle brachytherapy for anal canal tumours, and 16 patients received electron beam therapy (20 Gy in 10 fractions in 2 weeks) for anal margin tumours. A defunctioning stoma was only created prior to chemoradiotherapy for fistula or severe anal pain.
  
  
  RESULTS
  The overall survival for the 36 patients treated with chemoradiotherapy followed by brachytherapy was 75 % (95 % CI, 61-89) at 5 years, the disease-specific survival was 91 % (95 % CI, 81-101 %), and the stoma-free survival was 97 % (95 % CI, 91-103 %) all at 5 years. For the 16 patients treated with an electron boost for anal margin tumours, the 5-year overall survival, disease-specific survival and stoma-free survival were 68 % (95 % CI, 44-92 %), 78 % (95 % CI, 56-100 %) and 80 % (95 % CI, 60-100 %), respectively.
  
  
  CONCLUSIONS
  A very low stoma formation rate can be obtained with radical chemoradiotherapy followed by a brachytherapy boost for squamous cell carcinoma of the anal canal but not with an electron boost for anal margin tumours.
authors.affiliation: Department of Clinical Oncology, Nottingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Kent
authors.affiliation: Department of Clinical Oncology, Nottingham, UK. ebessell@hotmail.co.uk.
authors.forename: E M
authors.initials: EM
authors.lastname: Bessell
authors.affiliation: Department of Surgery, Nottingham, UK.
authors.forename: J H
authors.initials: JH
authors.lastname: Scholefield
authors.affiliation: School of Life Sciences, University of Nottingham, Nottingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Chappell
authors.affiliation: Department of Clinical Oncology, Nottingham, UK.
authors.forename: L
authors.initials: L
authors.lastname: Marsh
authors.affiliation: Department of Clinical Oncology, Nottingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Mills
authors.affiliation: Department of Clinical Oncology, Nottingham, UK.
authors.forename: I
authors.initials: I
authors.lastname: Sayers
mesh_terms: D001005:Anus Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D001918:Brachytherapy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D003125:Colostomy; D004583:Electrons; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
keywords: Anal cancer; Boost; Brachytherapy; Electron beam therapy; Radiotherapy; Stoma formation