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Total duration of treatment associated with local, colostomy failure in anal cancer
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Total treatment time had an injurious effect on local failure and colostomy failure in patients with anal cancer, according to pooled results from the RTOG 87-04 and RTOG 98-11 trials. Duration of radiation therapy appeared to have no effect.
“The implication of our findings is that the use of more intensive regimens with shorter total treatment time may improve local control and reduce colostomy rate,” the researchers wrote. “Therefore, concurrent chemoradiotherapy regimens may have an advantage over regimens including induction chemotherapy.”
Researchers combined data from the trials to form three treatment groups: 472 patients assigned to radiation/fluorouracil/mitomycin, 320 assigned to radiation/FU/cisplatin and 145 assigned to radiation/FU.
Median follow-up was 3.2 years in the radiation/FU/mitomycin group, 2.6 years for the radiation/FU/cisplatin group and 8.7 years in the radiation/FU group.
Univariate analysis showed a statistically significant association between total treatment time and colostomy failure (HR=1.51; 95% CI, 1.07-2.14) and local failure (HR=1.52; 95% CI, 1.14-2.03). Additionally, prolonged total treatment duration was associated with higher rates of local regional failure (HR=1.51; 95% CI, 1.15-1.98) and time to treatment failure (HR=1.40; 95% CI, 1.10-1.79).
Duration and intensity of radiation therapy were not significantly associated with any outcome.
Researchers said patients in the radiation/FU/cisplatin (HR=1.59; 95% CI, 1.08-2.35) and radiation/FU groups (HR=1.86; 95% CI, 1.18-2.94) were at increased risk for colostomy failure compared with those in the radiation/FU/mitomycin group. Patients in those two groups were also at greater risk for local failure, locoregional failure and time to treatment failure.
After adjusting for treatment group, researchers observed a statistically significant association between total treatment duration and local failure, locoregional failure and time to treatment failure.
After adjusting for treatment group, age, sex, Karnofsky performance score, T stage and N stage, researchers found no association between radiation dose, duration and intensity and colostomy failure or local failure on multivariate analysis.
For more information:
- Ben-Josef E. J Clin Oncol. 2010;doi:10.1200/JCO.2010.29.1351.