title: Replacing 5-fluorouracil by capecitabine in localised squamous cell carcinoma of the anal canal: systematic review and meta-analysis.
abstract: BACKGROUND
  The standard treatment for localised squamous cell carcinoma of the anal canal (SCCAC) is chemoradiotherapy (CRT) with infusional 5-fluorouracil (5-FU) and mitomycin. Because 5-FU and capecitabine have offered similar efficacy in many phase-III trials of solid tumours, studies have tested capecitabine in this setting of SCCAC. However, these studies are small and have reported variable results. Therefore, a systematic review and meta-analysis was performed.
  
  
  METHODS
  Medline, Scopus and Embase were searched for studies that evaluated the efficacy outcomes of capecitabine used as a substitute of 5-FU in the CRT of localised SCCAC. The primary endpoint was complete response rate (CRR) at 6 months. Metaprop analysis of reported CRR-based on pooled estimates of proportions with corresponding 95% confidence intervals (95%CI) were calculated on the base of the Freeman-Tukey double arcsine transformation.
  
  
  RESULTS
  We retrieved 300 studies, of which six met our eligibility criteria. The capecitabine dose ranged from 500 mg/m2to 825 mg/m2BID for 5 days per week during radiation. With a total of 218 patients, the median follow-up was 21.5 months (14-23). The pooled analysis of three trials (N= 132 patients) reported a CRR at 6 months of 88% (83%-94%), considering all clinical stages. The pooled analysis of overall CRR (N= 218 patients), evaluated at different intervals, showed an overall CRR of 91% (87%-95%). Rates of locoregional relapse varied from 3.2% to 21%. The majority of patients completed the planned radiotherapy dose (93.5%-100%) and any chemotherapy interruption was reported in up to 55.8% of patients.
  
  
  CONCLUSIONS
  Capecitabine is an acceptable and more convenient alternative to infusional 5-FU in the CRT for localised SCCAC, offering similar clinical CRR to those reported by phase-III trials.
authors.affiliation: Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, São Paulo 01246-000, Brazil.
authors.forename: Karla T
authors.initials: KT
authors.lastname: Souza
authors.affiliation: Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, São Paulo 01246-000, Brazil.
authors.forename: Allan Al
authors.initials: AA
authors.lastname: Pereira
authors.affiliation: Department of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Barretos Cancer Hospital, Barretos 14784-400, Brazil.
authors.forename: Raphael L
authors.initials: RL
authors.lastname: Araujo
authors.affiliation: Universidade Estadualdo Piaui, Teresina 64049522, Brazil.
authors.forename: Suilane Coelho Ribeiro
authors.initials: SC
authors.lastname: Oliveira
authors.affiliation: Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, São Paulo 01246-000, Brazil.
authors.forename: Paulo M
authors.initials: PM
authors.lastname: Hoff
authors.affiliation: Department of Radiology and Oncology, Instituto do Cancer do Estado de São Paulo, São Paulo 01246-000, Brazil.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Riechelmann
keywords: anal canal neoplasm; anal cancer; anus neoplasm; capecitabine; chemoradiation