Concurrent chemotherapy and intensity modulated radiation therapy in the treatment of anal cancer: A retrospective review from a large academic center

Purpose: To assess the toxicity and efficacy of intensity modulated radiation therapy (IMRT) combined with chemotherapy in treatment of anal cancer. Methods and Materials: We examined the records of 34 consecutive patients who received chemoradiation therapy with IMRT as initial treatment for squamous cell carcinoma of the anus between June 2005 and January 2009. The median radiation dose was 50.4 Gy (range, 48.6-57.6 Gy). Chemotherapy was given concurrently: 5-fluorouracil alone in 1 patient and combination 5-fluorouracil and mitomycin C in all others. Endpoints included local control and survival, as well as toxicity. Acute and late toxicity was scored with the Common Terminology Criteria for Adverse Events version 3.0. Results: Twenty-eight patients presented with T1 and T2 disease and 6 with T3 and T4 disease. Fourteen patients had regional nodal metastases. The median age was 59 years (range, 46-85 years). Median follow-up in surviving patients was 22 months. The estimated 2-year survival was 93% (95% confidence interval, 76%-98%). Three patients (9%) had local relapse (estimated 2-year local control, 90%; 95% confidence interval, 74%-97%). One patient had relapse in a regional node. Acute grade 3-4 hematologic toxicity was observed in 20 patients (59%). Other acute grade 3 or grade 4 toxicity included the gastrointestinal tract in 3 patients (9%) and skin in 5 patients (15%). Two patients (6%) had late grade 3 or grade 4 gastrointestinal tract toxicity. Conclusions: Treatment of anal squamous cell carcinoma with IMRT and chemotherapy is effective and has an acceptable toxicity profile.