Cisplatin-based combined modality therapy for anal carcinoma

A wider therapeutic index

Arthur Hung, Christopher Crane, Marc Delclos, Matthew Ballo, Jaffer Ajani, Edward Lin, Barry Feig, John Skibber, Nora Janjan

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

BACKGROUND. Definitive chemoradiation therapy is the standard of care for anal carcinoma. The chemotherapy regimen comprising 5-fluorouracil (5-FU) and mitomycin-C is the most commonly used among patients with anal carcinoma but causes well documented toxicities. In the current study, the authors evaluated their experience in treating anal carcinoma with combined modality therapy using cisplatin and 5-FU. METHODS. A retrospective analysis was performed of 92 patients with nonmetastatic squamous cell carcinoma of the anus who were treated between 1989 and 1998. The primary tumor and involved lymph nodes received a total dose of 55 grays (Gy) administered in more than 30 daily fractions. Cisplatin (4 mg/m2/day) and 5-FU (250 mg/m2/day) were given as a continuous infusion, 5 days each week during the entire radiation course. Kaplan-Meier methodology was used to determine local control (LC), disease-free survival (DFS), and overall survival (OS). RESULTS. Ten patients had T1 or Tx, 43 had T2, 27 had T3, and 12 patients had T4 disease. There were 21 male and 71 female patients. Sixty-five patients (71%) were lymph node negative. With a median follow-up duration of 44 months, the actuarial 5-year OS rate was 85%, the DFS rate was 77%, and the colostomy-free survival rate was 82%. Local recurrences occurred in 16 patients (17%). Distant metastases (DM) occurred in eight patients (9%). Advanced T classification (> T2) predicted lower LC and DFS rates. Advanced N classification (> N1) predicted worse DFS, OS, and DM rates. Greater than 90% of patients completed treatment without significant treatment interruption. Only five patients developed acute toxicities of Radiation Therapy Oncology Group (RTOG) Grade 4 or higher and only three patients developed chronic toxicities of RTOG Grade 4 or higher. CONCLUSIONS. Combined modality therapy with continuous infusion of cisplatin and 5-FU is a well tolerated regimen that results in high rates of LC, OS, and sphincter preservation. These rates are comparable to the best results reported with mitomycin-C and 5-FU. Without the normally severe toxicity, cisplatin-based therapy results in a wider therapeutic index.

Original languageEnglish (US)
Pages (from-to)1195-1202
Number of pages8
JournalCancer
Volume97
Issue number5
DOIs
StatePublished - Mar 1 2003

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Combined Modality Therapy
Cisplatin
Carcinoma
Fluorouracil
Disease-Free Survival
Survival Rate
Therapeutics
Radiation Oncology
Mitomycin
Survival
Radiotherapy
Lymph Nodes
Neoplasm Metastasis
Colostomy
Anal Canal
Standard of Care
Squamous Cell Carcinoma
Radiation

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Hung, A., Crane, C., Delclos, M., Ballo, M., Ajani, J., Lin, E., ... Janjan, N. (2003). Cisplatin-based combined modality therapy for anal carcinoma: A wider therapeutic index. Cancer, 97(5), 1195-1202. https://doi.org/10.1002/cncr.11161

Cisplatin-based combined modality therapy for anal carcinoma : A wider therapeutic index. / Hung, Arthur; Crane, Christopher; Delclos, Marc; Ballo, Matthew; Ajani, Jaffer; Lin, Edward; Feig, Barry; Skibber, John; Janjan, Nora.

In: Cancer, Vol. 97, No. 5, 01.03.2003, p. 1195-1202.

Research output: Contribution to journalArticle

Hung, A, Crane, C, Delclos, M, Ballo, M, Ajani, J, Lin, E, Feig, B, Skibber, J & Janjan, N 2003, 'Cisplatin-based combined modality therapy for anal carcinoma: A wider therapeutic index', Cancer, vol. 97, no. 5, pp. 1195-1202. https://doi.org/10.1002/cncr.11161
Hung, Arthur ; Crane, Christopher ; Delclos, Marc ; Ballo, Matthew ; Ajani, Jaffer ; Lin, Edward ; Feig, Barry ; Skibber, John ; Janjan, Nora. / Cisplatin-based combined modality therapy for anal carcinoma : A wider therapeutic index. In: Cancer. 2003 ; Vol. 97, No. 5. pp. 1195-1202.
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abstract = "BACKGROUND. Definitive chemoradiation therapy is the standard of care for anal carcinoma. The chemotherapy regimen comprising 5-fluorouracil (5-FU) and mitomycin-C is the most commonly used among patients with anal carcinoma but causes well documented toxicities. In the current study, the authors evaluated their experience in treating anal carcinoma with combined modality therapy using cisplatin and 5-FU. METHODS. A retrospective analysis was performed of 92 patients with nonmetastatic squamous cell carcinoma of the anus who were treated between 1989 and 1998. The primary tumor and involved lymph nodes received a total dose of 55 grays (Gy) administered in more than 30 daily fractions. Cisplatin (4 mg/m2/day) and 5-FU (250 mg/m2/day) were given as a continuous infusion, 5 days each week during the entire radiation course. Kaplan-Meier methodology was used to determine local control (LC), disease-free survival (DFS), and overall survival (OS). RESULTS. Ten patients had T1 or Tx, 43 had T2, 27 had T3, and 12 patients had T4 disease. There were 21 male and 71 female patients. Sixty-five patients (71{\%}) were lymph node negative. With a median follow-up duration of 44 months, the actuarial 5-year OS rate was 85{\%}, the DFS rate was 77{\%}, and the colostomy-free survival rate was 82{\%}. Local recurrences occurred in 16 patients (17{\%}). Distant metastases (DM) occurred in eight patients (9{\%}). Advanced T classification (> T2) predicted lower LC and DFS rates. Advanced N classification (> N1) predicted worse DFS, OS, and DM rates. Greater than 90{\%} of patients completed treatment without significant treatment interruption. Only five patients developed acute toxicities of Radiation Therapy Oncology Group (RTOG) Grade 4 or higher and only three patients developed chronic toxicities of RTOG Grade 4 or higher. CONCLUSIONS. Combined modality therapy with continuous infusion of cisplatin and 5-FU is a well tolerated regimen that results in high rates of LC, OS, and sphincter preservation. These rates are comparable to the best results reported with mitomycin-C and 5-FU. Without the normally severe toxicity, cisplatin-based therapy results in a wider therapeutic index.",
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T1 - Cisplatin-based combined modality therapy for anal carcinoma

T2 - A wider therapeutic index

AU - Hung, Arthur

AU - Crane, Christopher

AU - Delclos, Marc

AU - Ballo, Matthew

AU - Ajani, Jaffer

AU - Lin, Edward

AU - Feig, Barry

AU - Skibber, John

AU - Janjan, Nora

PY - 2003/3/1

Y1 - 2003/3/1

N2 - BACKGROUND. Definitive chemoradiation therapy is the standard of care for anal carcinoma. The chemotherapy regimen comprising 5-fluorouracil (5-FU) and mitomycin-C is the most commonly used among patients with anal carcinoma but causes well documented toxicities. In the current study, the authors evaluated their experience in treating anal carcinoma with combined modality therapy using cisplatin and 5-FU. METHODS. A retrospective analysis was performed of 92 patients with nonmetastatic squamous cell carcinoma of the anus who were treated between 1989 and 1998. The primary tumor and involved lymph nodes received a total dose of 55 grays (Gy) administered in more than 30 daily fractions. Cisplatin (4 mg/m2/day) and 5-FU (250 mg/m2/day) were given as a continuous infusion, 5 days each week during the entire radiation course. Kaplan-Meier methodology was used to determine local control (LC), disease-free survival (DFS), and overall survival (OS). RESULTS. Ten patients had T1 or Tx, 43 had T2, 27 had T3, and 12 patients had T4 disease. There were 21 male and 71 female patients. Sixty-five patients (71%) were lymph node negative. With a median follow-up duration of 44 months, the actuarial 5-year OS rate was 85%, the DFS rate was 77%, and the colostomy-free survival rate was 82%. Local recurrences occurred in 16 patients (17%). Distant metastases (DM) occurred in eight patients (9%). Advanced T classification (> T2) predicted lower LC and DFS rates. Advanced N classification (> N1) predicted worse DFS, OS, and DM rates. Greater than 90% of patients completed treatment without significant treatment interruption. Only five patients developed acute toxicities of Radiation Therapy Oncology Group (RTOG) Grade 4 or higher and only three patients developed chronic toxicities of RTOG Grade 4 or higher. CONCLUSIONS. Combined modality therapy with continuous infusion of cisplatin and 5-FU is a well tolerated regimen that results in high rates of LC, OS, and sphincter preservation. These rates are comparable to the best results reported with mitomycin-C and 5-FU. Without the normally severe toxicity, cisplatin-based therapy results in a wider therapeutic index.

AB - BACKGROUND. Definitive chemoradiation therapy is the standard of care for anal carcinoma. The chemotherapy regimen comprising 5-fluorouracil (5-FU) and mitomycin-C is the most commonly used among patients with anal carcinoma but causes well documented toxicities. In the current study, the authors evaluated their experience in treating anal carcinoma with combined modality therapy using cisplatin and 5-FU. METHODS. A retrospective analysis was performed of 92 patients with nonmetastatic squamous cell carcinoma of the anus who were treated between 1989 and 1998. The primary tumor and involved lymph nodes received a total dose of 55 grays (Gy) administered in more than 30 daily fractions. Cisplatin (4 mg/m2/day) and 5-FU (250 mg/m2/day) were given as a continuous infusion, 5 days each week during the entire radiation course. Kaplan-Meier methodology was used to determine local control (LC), disease-free survival (DFS), and overall survival (OS). RESULTS. Ten patients had T1 or Tx, 43 had T2, 27 had T3, and 12 patients had T4 disease. There were 21 male and 71 female patients. Sixty-five patients (71%) were lymph node negative. With a median follow-up duration of 44 months, the actuarial 5-year OS rate was 85%, the DFS rate was 77%, and the colostomy-free survival rate was 82%. Local recurrences occurred in 16 patients (17%). Distant metastases (DM) occurred in eight patients (9%). Advanced T classification (> T2) predicted lower LC and DFS rates. Advanced N classification (> N1) predicted worse DFS, OS, and DM rates. Greater than 90% of patients completed treatment without significant treatment interruption. Only five patients developed acute toxicities of Radiation Therapy Oncology Group (RTOG) Grade 4 or higher and only three patients developed chronic toxicities of RTOG Grade 4 or higher. CONCLUSIONS. Combined modality therapy with continuous infusion of cisplatin and 5-FU is a well tolerated regimen that results in high rates of LC, OS, and sphincter preservation. These rates are comparable to the best results reported with mitomycin-C and 5-FU. Without the normally severe toxicity, cisplatin-based therapy results in a wider therapeutic index.

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