R Yeung1, Y McConnell2, G Roxin2, R Banerjee1, G B Roldán Urgoiti3, A R MacLean2, W D Buie2, K E Mulder4, M M Vickers5, K J Joseph6, C M Doll1. 1. Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB. 2. Department of Surgery, University of Calgary, Calgary, AB. 3. Department of Internal Medicine and Oncology, University of Calgary, Calgary, AB. 4. Department of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB. 5. Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB. 6. Department of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB.
Abstract
BACKGROUND: Concurrent chemoradiation with fluorouracil (5fu) and mitomycin C (mmc) is standard treatment for anal canal carcinoma (acc). The current protocol in Alberta is administration of 5fu and mmc during weeks 1 and 5 of radiation. However, administration of the second bolus of mmc has been based largely on centre preference. Given limited published data on outcomes with different mmc regimens, our objective was to compare the efficacy and toxicity of 1 compared with 2 cycles of mmc in acc treatment. METHODS: Our retrospective study evaluated 169 acc patients treated with radical chemoradiotherapy between 2000 and 2010 at two tertiary cancer centres. All patients were treated with 2 cycles of 5fu and with 1 cycle (mmc1) or 2 cycles (mmc2) of mmc. Acute toxicities, disease-free (dfs) and overall survival (os) were analyzed. RESULTS: Baseline demographics, performance status, and stage were similar in the groups of patients who received mmc1 (52%) and mmc2 (48%). Before treatment, median hematologic parameters were comparable, except for white blood cell count, which was higher in the mmc2 group, but within normal range. The 5-year os and dfs were similar (75.1% and 54.2% for mmc1 vs. 70.7% and 44.2% for mmc2, p = 0.98 and p = 0.63 respectively). On multivariate analysis, mmc2 was the factor most strongly associated with specific acute toxicities: grade 3+ leukopenia (hazard ratio: 4.82; p < 0.01), grade 3+ skin toxicity (hazard ratio: 4.76; p < 0.001), and hospitalizations secondary to febrile neutropenia (hazard ratio: 9.91; p = 0.001). CONCLUSIONS: In definitive chemoradiotherapy for acc, 1 cycle of mmc appears to offer outcomes similar to those achieved with 2 cycles, with significantly less acute toxicity.
BACKGROUND: Concurrent chemoradiation with fluorouracil (5fu) and mitomycin C (mmc) is standard treatment for anal canal carcinoma (acc). The current protocol in Alberta is administration of 5fu and mmc during weeks 1 and 5 of radiation. However, administration of the second bolus of mmc has been based largely on centre preference. Given limited published data on outcomes with different mmc regimens, our objective was to compare the efficacy and toxicity of 1 compared with 2 cycles of mmc in acc treatment. METHODS: Our retrospective study evaluated 169 acc patients treated with radical chemoradiotherapy between 2000 and 2010 at two tertiary cancer centres. All patients were treated with 2 cycles of 5fu and with 1 cycle (mmc1) or 2 cycles (mmc2) of mmc. Acute toxicities, disease-free (dfs) and overall survival (os) were analyzed. RESULTS: Baseline demographics, performance status, and stage were similar in the groups of patients who received mmc1 (52%) and mmc2 (48%). Before treatment, median hematologic parameters were comparable, except for white blood cell count, which was higher in the mmc2 group, but within normal range. The 5-year os and dfs were similar (75.1% and 54.2% for mmc1 vs. 70.7% and 44.2% for mmc2, p = 0.98 and p = 0.63 respectively). On multivariate analysis, mmc2 was the factor most strongly associated with specific acute toxicities: grade 3+ leukopenia (hazard ratio: 4.82; p < 0.01), grade 3+ skin toxicity (hazard ratio: 4.76; p < 0.001), and hospitalizations secondary to febrile neutropenia (hazard ratio: 9.91; p = 0.001). CONCLUSIONS: In definitive chemoradiotherapy for acc, 1 cycle of mmc appears to offer outcomes similar to those achieved with 2 cycles, with significantly less acute toxicity.
Authors: Luis O Olivatto; Vânia Cabral; Arthur Rosa; Marcos Bezerra; Erick Santarem; Ana Fassizoli; Leonaldson Castro; José Humberto Simões; Isabele A Small; Carlos Gil Ferreira Journal: Int J Radiat Oncol Biol Phys Date: 2010-05-14 Impact factor: 7.038
Authors: H Bartelink; F Roelofsen; F Eschwege; P Rougier; J F Bosset; D G Gonzalez; D Peiffert; M van Glabbeke; M Pierart Journal: J Clin Oncol Date: 1997-05 Impact factor: 44.544
Authors: J Northover; R Glynne-Jones; D Sebag-Montefiore; R James; H Meadows; S Wan; M Jitlal; J Ledermann Journal: Br J Cancer Date: 2010-03-16 Impact factor: 7.640
Authors: Leonard L Gunderson; Kathryn A Winter; Jaffer A Ajani; John E Pedersen; Jennifer Moughan; Al B Benson; Charles R Thomas; Robert J Mayer; Michael G Haddock; Tyvin A Rich; Christopher G Willett Journal: J Clin Oncol Date: 2012-11-13 Impact factor: 44.544
Authors: Cathy Eng; George J Chang; Y Nancy You; Prajnan Das; Yan Xing; Marc Delclos; Robert A Wolff; Miguel A Rodriguez-Bigas; John Skibber; Aki Ohinata; Spencer Gould; Jonathan Phillips; Christopher H Crane Journal: Cancer Date: 2013-08-20 Impact factor: 6.860
Authors: L Leichman; N Nigro; V K Vaitkevicius; B Considine; T Buroker; G Bradley; H G Seydel; S Olchowski; G Cummings; C Leichman Journal: Am J Med Date: 1985-02 Impact factor: 4.965
Authors: Grace Lee; Daniel W Kim; Vinayak Muralidhar; Devarati Mitra; Nora K Horick; Christine E Eyler; Theodore S Hong; Lorraine C Drapek; Jill N Allen; Lawrence S Blaszkowsky; Bruce Giantonio; Aparna R Parikh; David P Ryan; Jeffrey W Clark; Jennifer Y Wo Journal: Oncologist Date: 2020-09-12
Authors: Paolo Goffredo; Alan F Utria; Jennifer E Hrabe; Irena Gribovskaja-Rupp; Muneera R Kapadia; Imran Hassan Journal: J Gastrointest Surg Date: 2019-01-14 Impact factor: 3.452