Intensified Induction Chemotherapy in Locally Advanced Squamous Cell Carcinoma of the Anus—A Population-Based Experience from the Danish Anal Cancer Group
by
and
Karen Lycke Wind
1,*, 
Lisbeth Riber
2,
Birgitte Mayland Havelund
2,
Eva Serup-Hansen
3,
Camilla Kronborg
4,
Mette Marie Fode
5,
Anders Jakobsen
2,†
and
Karen-Lise Garm Spindler
1,† 1
Department of Experimental Clinical Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark
2
Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark
3
Department of Oncology, Herlev and Gentofte Hospital, 2730 Herlev, Denmark
4
Danish Centre for Particle Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark
5
Department of Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark
*
Author to whom correspondence should be addressed.
†
These authors share senior authorship.
Cancers 2021, 13(13), 3226; https://doi.org/10.3390/cancers13133226
Submission received: 19 May 2021
/
Revised: 18 June 2021
/
Accepted: 22 June 2021
/
Published: 28 June 2021
(This article belongs to the Special Issue Research on Anal Squamous Cell Carcinoma)
Simple Summary
The primary treatment modality for anal cancer is chemoradiotherapy, but patients with locally advanced disease (i.e., large tumors and/or involvement of regional lymph nodes) have a high risk of treatment failure. The use of chemotherapy prior to radiotherapy (induction chemotherapy) can potentially shrink the tumor and/or eradicate small cancer cells with metastatic potential, with a chance of a better outcome. With this paper, the authors present 20 years of nationwide experience with intensified induction chemotherapy in the treatment of locally advanced anal cancer, which indicates a role for further investigation in the most advanced cases.
Abstract
Locally advanced squamous cell carcinoma of the anus (LASCCA) has a poor prognosis with a high risk of treatment failure calling for intensified therapy. We present the long-term follow-up of a nationwide cohort of LASCCA treated with intensified induction chemotherapy (ICT). The study included patients with LASCCA (T3-4N0 or T1-4N+) treated with at least one cycle of ICT (cisplatin, ifosfamide, leucoverin, and 5-flourouracil) between 1998–2018. Data were retrospectively collected from medical records, and statistics were performed in STATA 16.1. In total, 166 patients with LASCCA were identified. Following ICT, 157 patients (95%) received primary curative treatment with either radiotherapy (70%), chemoradiotherapy (27%), or abdominal perineal resection (3%). The overall local tumor response rate after ICT was 76% with 20 (13%) achieving complete local tumor response. After the primary treatment, 123 patients (79%) obtained complete response, and 27 underwent salvage surgery due to persistent disease. The median follow-up time was 6 years, local and distant failure rates 22% and 13%, respectively. The 3- and 5-year disease-free survival rates were 70% and 67%, and the 3- and 5-year overall survival rates were 76% and 70%, respectively. Intensified ICT regimen could be a supplementary treatment option in the most advanced cases of LASCCA. Prospective randomized trials are needed to investigate this approach further.
