Protocol for anal carcinoma: a retrospective review at the Department of Oncology Universitas Academic Hospital Bloemfontein
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Date
2021
Authors
Buthelezi, Thandeka Nompumelelo
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Background: Anal carcinoma is an uncommon cancer worldwide. Standard therapy is chemoradiation as it is not only curative but also has the advantage of organ preservation. In our department we see mostly locally advanced carcinomas as opposed to the early stage disease investigated in international articles. The standard dose for chemoradiation is 55-59 Gy. We have given up to 70Gy in locally advanced disease. Objectives: We aimed to assess whether the higher dose of up to 66-70 Gy, given in our department to locally advanced disease is improving survival and has a comparable side effect profile to the standard radiation dose. Method: As will be explained later, only patients that were from the Free State and treated in our department from 2001 to 2010 were included in the study sample. Clinical records were used to obtain data. The total number of participants were 28. Only patients that received chemoradiation or radiation only were included. The data analysed were: local demographics, local control, acute and late toxicity, colostomy free survival and progression free survival with correlation to the total radiation dose received .Numerical variables were summarised using medians and interquartile ranges. Categorical variables were summarised using frequencies and percentages. Results: Males made up 57,1% of the participants and females 42,9%. The mean age was 45 with the youngest being 21 years old. Twelve of the participants had HIV infection. Ninety one percent of the patients had squamous cell carcinoma. All presented with locally advanced disease. Five patients defaulted post radiation. Participants that received split course radiation were 86%, 7% received continuous radiation to a total dose of 50,4 Gy,3,6% 38 Gy and 3,6% 3740cGy . The highest radiation dose received was 60 Gy. On follow-up 12 (43%) had a complete response 11(39%) had residual disease. Majority (75%) already had colostomies prior to starting treatment, three never required one. Conclusion: The primary end point was not met as none of the patients received the dose we were aiming to assess due to exclusion criteria. Observations made with regards to demographics and side effect profile were in keeping with published literature. PFS and OS were less due to the majority of the patients having poor prognostic features and poor patient follow up. The majority of the patients were treated with radiation doses lower than 55 Gy which is the recommended minimum for locally advanced disease.
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Keywords
Dissertation (M.Med. (Oncology))--University of the Free State, [2021], Anal carcinoma, Chemotherapy, Radiation, Survival, Toxicity, Anal fistula, HIV and AIDS