Multimodality therapy including salvage surgical resection and intraoperative radiotherapy for patients with squamous-cell carcinoma of the anus with residual or recurrent disease after primary chemoradiotherapy

Christopher Hallemeier, Y. Nancy You, David Larson, Eric Dozois, Heidi Nelson, Kristi A. Klein, Robert C. Miller, Michael Haddock

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

BACKGROUND: For patients with residual or recurrent squamous-cell carcinoma of the anus after primary chemoradiotherapy, the standard treatment is surgical salvage. Patients with unresectable or borderline unresectable disease have poor outcomes, thus adjunctive treatments should be explored. OBJECTIVE: The aim of this study is to report outcomes for patients with residual/recurrent anal cancer treated with multimodality therapy including salvage surgical resection and intraoperative radiotherapy. DESIGN: This is an observational study. SETTINGS: This study was conducted at a tertiary referral center. PATIENTS: Thirty-two patients were treated between 1993 and 2012. Median age was 53 years (range, 3487). Salvage treatment was performed for residual disease (n = 9), first recurrence (n = 17), or second recurrence (n = 6) after primary chemoradiotherapy. INTERVENTIONS: Patients with recurrent disease received preoperative external beam reirradiation with concurrent chemotherapy. All patients underwent salvage surgical resection and intraoperative radiotherapy. Extent of surgical resection was R0 (negative margins, n = 16), R1 (microscopic residual, n = 13), or R2 (macroscopic residual, n = 3). The median intraoperative radiotherapy dose was 12.5 Gy. MAIN OUTCOME MEASURES: Treatment-related adverse events were classified according to the National Cancer Institute Common Toxicity Criteria. Overall and diseasefree survival were estimated by using the Kaplan- Meier technique. Central, local-regional, and distant failure were estimated by the use of the cumulative incidence method. RESULTS: Median length of hospital stay was 9 days. Mortality at 30 days after surgery and intraoperative radiotherapy was 0%. Fifteen patients (47%) experienced a total of 16 grade 3 treatment-related adverse events (wound complication (n = 6), bowel obstruction (n = 5), and ureteral obstruction (n = 3)). The 5-year estimates of overall and disease-free survival were 23% and 17%. The 5-year estimates of central, local-regional, and distant failure were 21%, 51%, and 40%. LIMITATIONS: This was a single-institution observational study with limited patient numbers. CONCLUSIONS: In this heavily pretreated, high-risk patient population, multimodality therapy including salvage surgery and intraoperative radiotherapy was associated with longterm survival in a small, but significant subset of patients.

Original languageEnglish (US)
Pages (from-to)442-448
Number of pages7
JournalDiseases of the Colon and Rectum
Volume57
Issue number4
DOIs
StatePublished - Apr 1 2014

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Salvage Therapy
Anal Canal
Chemoradiotherapy
Squamous Cell Carcinoma
Radiotherapy
Observational Studies
Length of Stay
Anus Neoplasms
Recurrence
Ureteral Obstruction
Survival
National Cancer Institute (U.S.)
Therapeutics
Ambulatory Surgical Procedures
Tertiary Care Centers
Disease-Free Survival
Drug Therapy

Keywords

  • Abdominoperineal resection
  • Anal cancer
  • Intraoperative radiotherapy
  • Multimodality therapy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{427f221f88dc4f909aec4a5e511f720a,
title = "Multimodality therapy including salvage surgical resection and intraoperative radiotherapy for patients with squamous-cell carcinoma of the anus with residual or recurrent disease after primary chemoradiotherapy",
abstract = "BACKGROUND: For patients with residual or recurrent squamous-cell carcinoma of the anus after primary chemoradiotherapy, the standard treatment is surgical salvage. Patients with unresectable or borderline unresectable disease have poor outcomes, thus adjunctive treatments should be explored. OBJECTIVE: The aim of this study is to report outcomes for patients with residual/recurrent anal cancer treated with multimodality therapy including salvage surgical resection and intraoperative radiotherapy. DESIGN: This is an observational study. SETTINGS: This study was conducted at a tertiary referral center. PATIENTS: Thirty-two patients were treated between 1993 and 2012. Median age was 53 years (range, 3487). Salvage treatment was performed for residual disease (n = 9), first recurrence (n = 17), or second recurrence (n = 6) after primary chemoradiotherapy. INTERVENTIONS: Patients with recurrent disease received preoperative external beam reirradiation with concurrent chemotherapy. All patients underwent salvage surgical resection and intraoperative radiotherapy. Extent of surgical resection was R0 (negative margins, n = 16), R1 (microscopic residual, n = 13), or R2 (macroscopic residual, n = 3). The median intraoperative radiotherapy dose was 12.5 Gy. MAIN OUTCOME MEASURES: Treatment-related adverse events were classified according to the National Cancer Institute Common Toxicity Criteria. Overall and diseasefree survival were estimated by using the Kaplan- Meier technique. Central, local-regional, and distant failure were estimated by the use of the cumulative incidence method. RESULTS: Median length of hospital stay was 9 days. Mortality at 30 days after surgery and intraoperative radiotherapy was 0{\%}. Fifteen patients (47{\%}) experienced a total of 16 grade 3 treatment-related adverse events (wound complication (n = 6), bowel obstruction (n = 5), and ureteral obstruction (n = 3)). The 5-year estimates of overall and disease-free survival were 23{\%} and 17{\%}. The 5-year estimates of central, local-regional, and distant failure were 21{\%}, 51{\%}, and 40{\%}. LIMITATIONS: This was a single-institution observational study with limited patient numbers. CONCLUSIONS: In this heavily pretreated, high-risk patient population, multimodality therapy including salvage surgery and intraoperative radiotherapy was associated with longterm survival in a small, but significant subset of patients.",
keywords = "Abdominoperineal resection, Anal cancer, Intraoperative radiotherapy, Multimodality therapy",
author = "Christopher Hallemeier and You, {Y. Nancy} and David Larson and Eric Dozois and Heidi Nelson and Klein, {Kristi A.} and Miller, {Robert C.} and Michael Haddock",
year = "2014",
month = "4",
day = "1",
doi = "10.1097/DCR.0000000000000071",
language = "English (US)",
volume = "57",
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journal = "Diseases of the Colon and Rectum",
issn = "0012-3706",
publisher = "Lippincott Williams and Wilkins",
number = "4",

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TY - JOUR

T1 - Multimodality therapy including salvage surgical resection and intraoperative radiotherapy for patients with squamous-cell carcinoma of the anus with residual or recurrent disease after primary chemoradiotherapy

AU - Hallemeier, Christopher

AU - You, Y. Nancy

AU - Larson, David

AU - Dozois, Eric

AU - Nelson, Heidi

AU - Klein, Kristi A.

AU - Miller, Robert C.

AU - Haddock, Michael

PY - 2014/4/1

Y1 - 2014/4/1

N2 - BACKGROUND: For patients with residual or recurrent squamous-cell carcinoma of the anus after primary chemoradiotherapy, the standard treatment is surgical salvage. Patients with unresectable or borderline unresectable disease have poor outcomes, thus adjunctive treatments should be explored. OBJECTIVE: The aim of this study is to report outcomes for patients with residual/recurrent anal cancer treated with multimodality therapy including salvage surgical resection and intraoperative radiotherapy. DESIGN: This is an observational study. SETTINGS: This study was conducted at a tertiary referral center. PATIENTS: Thirty-two patients were treated between 1993 and 2012. Median age was 53 years (range, 3487). Salvage treatment was performed for residual disease (n = 9), first recurrence (n = 17), or second recurrence (n = 6) after primary chemoradiotherapy. INTERVENTIONS: Patients with recurrent disease received preoperative external beam reirradiation with concurrent chemotherapy. All patients underwent salvage surgical resection and intraoperative radiotherapy. Extent of surgical resection was R0 (negative margins, n = 16), R1 (microscopic residual, n = 13), or R2 (macroscopic residual, n = 3). The median intraoperative radiotherapy dose was 12.5 Gy. MAIN OUTCOME MEASURES: Treatment-related adverse events were classified according to the National Cancer Institute Common Toxicity Criteria. Overall and diseasefree survival were estimated by using the Kaplan- Meier technique. Central, local-regional, and distant failure were estimated by the use of the cumulative incidence method. RESULTS: Median length of hospital stay was 9 days. Mortality at 30 days after surgery and intraoperative radiotherapy was 0%. Fifteen patients (47%) experienced a total of 16 grade 3 treatment-related adverse events (wound complication (n = 6), bowel obstruction (n = 5), and ureteral obstruction (n = 3)). The 5-year estimates of overall and disease-free survival were 23% and 17%. The 5-year estimates of central, local-regional, and distant failure were 21%, 51%, and 40%. LIMITATIONS: This was a single-institution observational study with limited patient numbers. CONCLUSIONS: In this heavily pretreated, high-risk patient population, multimodality therapy including salvage surgery and intraoperative radiotherapy was associated with longterm survival in a small, but significant subset of patients.

AB - BACKGROUND: For patients with residual or recurrent squamous-cell carcinoma of the anus after primary chemoradiotherapy, the standard treatment is surgical salvage. Patients with unresectable or borderline unresectable disease have poor outcomes, thus adjunctive treatments should be explored. OBJECTIVE: The aim of this study is to report outcomes for patients with residual/recurrent anal cancer treated with multimodality therapy including salvage surgical resection and intraoperative radiotherapy. DESIGN: This is an observational study. SETTINGS: This study was conducted at a tertiary referral center. PATIENTS: Thirty-two patients were treated between 1993 and 2012. Median age was 53 years (range, 3487). Salvage treatment was performed for residual disease (n = 9), first recurrence (n = 17), or second recurrence (n = 6) after primary chemoradiotherapy. INTERVENTIONS: Patients with recurrent disease received preoperative external beam reirradiation with concurrent chemotherapy. All patients underwent salvage surgical resection and intraoperative radiotherapy. Extent of surgical resection was R0 (negative margins, n = 16), R1 (microscopic residual, n = 13), or R2 (macroscopic residual, n = 3). The median intraoperative radiotherapy dose was 12.5 Gy. MAIN OUTCOME MEASURES: Treatment-related adverse events were classified according to the National Cancer Institute Common Toxicity Criteria. Overall and diseasefree survival were estimated by using the Kaplan- Meier technique. Central, local-regional, and distant failure were estimated by the use of the cumulative incidence method. RESULTS: Median length of hospital stay was 9 days. Mortality at 30 days after surgery and intraoperative radiotherapy was 0%. Fifteen patients (47%) experienced a total of 16 grade 3 treatment-related adverse events (wound complication (n = 6), bowel obstruction (n = 5), and ureteral obstruction (n = 3)). The 5-year estimates of overall and disease-free survival were 23% and 17%. The 5-year estimates of central, local-regional, and distant failure were 21%, 51%, and 40%. LIMITATIONS: This was a single-institution observational study with limited patient numbers. CONCLUSIONS: In this heavily pretreated, high-risk patient population, multimodality therapy including salvage surgery and intraoperative radiotherapy was associated with longterm survival in a small, but significant subset of patients.

KW - Abdominoperineal resection

KW - Anal cancer

KW - Intraoperative radiotherapy

KW - Multimodality therapy

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