Very Late-Onset Serious Chronic Adverse Effects After Radical Chemoradiotherapy for Anal Canal Cancer
Abstract
:1. Introduction
2. Case History
- -
- Mitomycin C 20 mg, intravenous injection, day 1;
- -
- 5-fluoruracil 750 mg/24 h, continuous intravenous infusion, days 1–4 and 29–32.
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
CT | Computer tomography |
CTV | Clinical target volume |
DRE | Digital rectal examination |
HBO | Hyperbaric oxygen |
IMRT | Intensity-modulated radiation therapy |
ORN | Osteoradionecrosis |
MRI | Magnetic resonance imaging |
RIF | Radiation-induced fibroatrophy |
VMAT | Volumetric modulated arch therapy |
References
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Step | Dose per Fraction | Number of Fractions | Volume | Technique | Dose | Cumulative Dose |
---|---|---|---|---|---|---|
1 | 1.2 Gy hyperfractionation 2 fractions/day | 48 (10 fractions/week) | anus, perianal skin, whole pelvis, and groins (CTV 1) | X-rays 5 MeV Isocentric 2 opposed fields (dorsal, ventral) | 57.6 Gy | 57.6 Gy |
2 | 2 Gy normofractionation | 5 (5 fractions/week) | anus, perianal skin, and dorsal pelvis (CTV 2) | X-rays 5 MeV Isocentric 4 fields (“box”) | 10 Gy | 67.6 Gy |
3 | 2 Gy normofractionation | 5 (5 fractions/week) | boost: anus perianal skin (CTV 3) | Electrons 15 MeV SSD 1 direct field | 10 Gy | 77.6 Gy |
Study, Reference | Number of Patients | Median Follow-Up Time | Late Effects | Incidence (Grading) | Colostomy Rate, Reason | Rem | |
---|---|---|---|---|---|---|---|
Relapse | Adverse Effects | ||||||
Gerard et al. [43] | 95 | 64 mo, (18 pts. > 8 years) | Anal necrosis | Any grade 14/95 (14.7%) | 11/95 (11.6%) | 6/95 (6.3%) | Median onset time 11 months (6–18) 18 pts. follow-up > 8 years |
De Bari et al. [7] | 120 | 65 mo (4–238) | Anorectal | G3 10/120 (7.5%) G4 1/120 (0.8%) | 16/122 (13.1%) | 2/120 (1.7%) | |
Ortholan et al. [20] | 66 | 66 mo | Bleeding Anal fibrosis Ulceration | G1-G2 10/66 (15.2%) G3 3—1/66 (1.5%) G1-G2—2/66 (3.0%) G1-G2—6/66 (9.1%) | 5/66 (7.5%) | 1/66 (1.5%) | |
UNICANCER ACCORD 03 trial Pfeiffert et al. [40] | 283 | 50 mo (0–102) | Ulceration/fistulation Bleeding Diarrhoea Incontinence | G3 21/283 (7.4%) G4 16/283 (5.6%) G3 77/283 (27.2%) G4 1/283 (0.4%) G3 10/283 (4%) G4 4/283 (1.4%) G3 35/283 (12.4%) G4 10/283 (4%) | 43/283 (15.2%) | 9/283 (3.2%) | |
Young et al. [41] | 120 | 21.6 mo (1–241) | Incontinence Bleeding Stenosis Telangiectasia | G1-G2 15/120 (12.5%) G1-G2 11/120 (9.2%) G1-G2 2/120 (1.7%) G1-G2 8/120 (6.7%) | 7/120 (5.8%) | 0/120 (0%) | No grade 3–4 late effects Median dose 39.6 Gy |
Swedish national ANCA cohort study Johansson et al. [42] | 388 | 85 mo (0–113) | n.a. | n.a. | n.a. | n.a. | Retrospective Swedish Cancer Registry-based study |
Madhu J. et al. [44] | 34 | 98 mo (8–169) | Skin ulceration Anal canal ulceration | G3–4 3/34 (8.8%) G3 1/34 (2.9%) | 0/34 (0%) | 0/34 (0%) |
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Vitek, P.; Kubes, J.; Ondrova, B.; Haas, A. Very Late-Onset Serious Chronic Adverse Effects After Radical Chemoradiotherapy for Anal Canal Cancer. J. Clin. Med. 2025, 14, 3841. https://doi.org/10.3390/jcm14113841
Vitek P, Kubes J, Ondrova B, Haas A. Very Late-Onset Serious Chronic Adverse Effects After Radical Chemoradiotherapy for Anal Canal Cancer. Journal of Clinical Medicine. 2025; 14(11):3841. https://doi.org/10.3390/jcm14113841
Chicago/Turabian StyleVitek, Pavel, Jiri Kubes, Barbora Ondrova, and Alexandra Haas. 2025. "Very Late-Onset Serious Chronic Adverse Effects After Radical Chemoradiotherapy for Anal Canal Cancer" Journal of Clinical Medicine 14, no. 11: 3841. https://doi.org/10.3390/jcm14113841
APA StyleVitek, P., Kubes, J., Ondrova, B., & Haas, A. (2025). Very Late-Onset Serious Chronic Adverse Effects After Radical Chemoradiotherapy for Anal Canal Cancer. Journal of Clinical Medicine, 14(11), 3841. https://doi.org/10.3390/jcm14113841