Irini Youssef1,2, Virginia Osborn3, Anna Lee1,2, Evangelia Katsoulakis4, Ami Kavi1,2, Kwang Choi1, Joseph Safdieh5, David Schreiber6. 1. SUNY Downstate Medical Center, Brooklyn, NY, USA. 2. Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. 3. Mount Sinai Elmhurst Faculty Practice Group, Queens, NY, USA. 4. Department of Veterans Affairs, James A. Haley Veterans' Hospital, Tampa, Florida, USA. 5. Kings County Hospital Center, Brooklyn, NY, USA. 6. Summit Medical Group MD Anderson Cancer Center, Florham Park, NJ, USA.
Abstract
BACKGROUND: Standard of care treatment for anal squamous cell carcinoma (SCC) is concurrent chemoradiation (CRT). However, the necessity of CRT over radiation alone for T1-2N0 disease is less certain. METHODS: The National Cancer Database (NCDB) was queried to identify patients who received CRT, defined as initiation of chemo and RT within 14 days of each other, or RT alone (without any chemo during initial treatment phase) for cT1-2N0M0 SCC of the anus. The cohort was limited to patients less than 70 years old with Charlson-Deyo Comorbidity Index of 0, receiving a radiation dose range of 4,500-5,940 cGy. Univariable and multivariable logistic regression were performed to assess for predictors of CRT usage. Five-year overall survival (OS) was analyzed using the Kaplan-Meier method with the log rank test both for the full cohort and then on the subsets of T1 and T2 patients. RESULTS: We identified 4,564 patients, of whom 4,371 (95.8%) received CRT and 193 (4.2%) received RT alone. Median follow up was 49.8 months. About 33.5% of patients had cT1N0 disease, while 66.5% of patients had cT2N0 disease. On multivariable logistic regression, patients were more likely to receive CRT if they had T2 disease [OR 2.318 (1.732-3.102), P<0.0001]. Five-year OS was 86.6% for CRT and 79.1% for RT (P=0.001). For T1 patients, 5-year OS was 90.3% with CRT and 84.7% with RT (P=0.114). For T2 patients, 5-year OS was 84.7% with CRT and 72.8% with RT (P<0.0001). Multivariable Cox regression analysis confirmed association between OS and CRT use [HR 0.588 (95% CI: 0.430-0.804), P=0.001]. CONCLUSIONS: The vast majority of patients under age 70 without significant comorbidities are treated with CRT over radiation alone for early stage anal SCC, with better survival associated with CRT.
BACKGROUND: Standard of care treatment for anal squamous cell carcinoma (SCC) is concurrent chemoradiation (CRT). However, the necessity of CRT over radiation alone for T1-2N0 disease is less certain. METHODS: The National Cancer Database (NCDB) was queried to identify patients who received CRT, defined as initiation of chemo and RT within 14 days of each other, or RT alone (without any chemo during initial treatment phase) for cT1-2N0M0 SCC of the anus. The cohort was limited to patients less than 70 years old with Charlson-Deyo Comorbidity Index of 0, receiving a radiation dose range of 4,500-5,940 cGy. Univariable and multivariable logistic regression were performed to assess for predictors of CRT usage. Five-year overall survival (OS) was analyzed using the Kaplan-Meier method with the log rank test both for the full cohort and then on the subsets of T1 and T2 patients. RESULTS: We identified 4,564 patients, of whom 4,371 (95.8%) received CRT and 193 (4.2%) received RT alone. Median follow up was 49.8 months. About 33.5% of patients had cT1N0 disease, while 66.5% of patients had cT2N0 disease. On multivariable logistic regression, patients were more likely to receive CRT if they had T2 disease [OR 2.318 (1.732-3.102), P<0.0001]. Five-year OS was 86.6% for CRT and 79.1% for RT (P=0.001). For T1 patients, 5-year OS was 90.3% with CRT and 84.7% with RT (P=0.114). For T2 patients, 5-year OS was 84.7% with CRT and 72.8% with RT (P<0.0001). Multivariable Cox regression analysis confirmed association between OS and CRT use [HR 0.588 (95% CI: 0.430-0.804), P=0.001]. CONCLUSIONS: The vast majority of patients under age 70 without significant comorbidities are treated with CRT over radiation alone for early stage anal SCC, with better survival associated with CRT.
Authors: Prajnan Das; Sumita Bhatia; Cathy Eng; Jaffer A Ajani; John M Skibber; Miguel A Rodriguez-Bigas; George J Chang; Priya Bhosale; Marc E Delclos; Sunil Krishnan; Nora A Janjan; Christopher H Crane Journal: Int J Radiat Oncol Biol Phys Date: 2007-03-26 Impact factor: 7.038
Authors: R J Myerson; F Kong; E H Birnbaum; J W Fleshman; I J Kodner; J Picus; G A Ratkin; T E Read; B J Walz Journal: Radiother Oncol Date: 2001-10 Impact factor: 6.280
Authors: Cécile Ortholan; Alain Ramaioli; Didier Peiffert; Antoine Lusinchi; Pascale Romestaing; Laurent Chauveinc; Emmanuel Touboul; Karine Peignaux; Antoine Bruna; Guy de La Roche; Jean-Léon Lagrange; Christian Alzieu; Jean Pierre Gerard Journal: Int J Radiat Oncol Biol Phys Date: 2005-06-01 Impact factor: 7.038
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; Jennifer Moughan; Jaffer A Ajani; John E Pedersen; Kathryn A Winter; Al B Benson; Charles R Thomas; Robert J Mayer; Michael G Haddock; Tyvin A Rich; Christopher G Willett Journal: Int J Radiat Oncol Biol Phys Date: 2013-09-10 Impact factor: 7.038
Authors: Robert J Myerson; Elesyia D Outlaw; Albert Chang; Elisa H Birnbaum; James W Fleshman; Perry W Grigsby; Ira J Kodner; Robert S Malayapa; Matthew G Mutch; Parag Parikh; Joel Picus; Benjamin R Tan Journal: Int J Radiat Oncol Biol Phys Date: 2009-02-27 Impact factor: 7.038
Authors: Jacob S Parzen; Aleksander Vayntraub; Bryan Squires; Muayad F Almahariq; Andrew B Thompson; John M Robertson; Peyman Kabolizadeh; Thomas J Quinn Journal: J Gastrointest Oncol Date: 2021-04
Authors: Joanna Gotfrit; Rachel Goodwin; Timothy Asmis; Angela J Hyde; Thierry Alcindor; Francine Aubin; Scott Berry; Dominick Bossé; Colin Brown; Ronald Burkes; Margot Burnell; Bruce Colwell; Jessica Corbett; Jeff Craswell; Nathalie Daaboul; Mark Doherty; D A Barry Fleming; Luisa Galvis; Rakesh Goel; Mohammed Harb; Alwin Jeyakumar; Derek Jonker; Erin Kennedy; Michael Lock; Aamer Mahmud; Patrick H McCrea; Vimoj Nair; Rami Nassabein; Carolyn Nessim; Ravi Ramjeesingh; Muhammad Raza; Wissam Saliba; Satareh Samimi; Simron Singh; Stephanie Snow; Mustapha Tehfé; Michael Thirlwell; Mario Valdes; Stephen Welch; Michael Vickers Journal: Curr Oncol Date: 2021-05-26 Impact factor: 3.677
Authors: Suleyman Y Goksu; Muhammet Ozer; Syed M A Kazmi; Todd A Aguilera; Chul Ahn; David Hsiehchen; Aravind Sanjeevaiah; Mary C Maxwell; Muhammad S Beg; Nina N Sanford Journal: Am J Clin Oncol Date: 2020-11 Impact factor: 2.787