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Predictive factors for toxicities in anal cancer treated by radiotherapy and chemotherapy

A study in this month's issue of the Diseases of the Colon & Rectum identifies predictive factors for early and late local toxicities in anal cancer treated by radiotherapy in combination with or without chemotherapy.

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The treatment of anal cancer is based on concomitant radiotherapy and chemotherapy and is associated with a nonnegligible rate of local severe toxicities that can strongly impair the quality of life.

Dr Jérôme Doyen and colleagues performed a retrospective analysis to screen for factors as potential predictive factors for local skin and digestive toxicities, and as potential prognostic factors for cumulative colostomy incidence.

The team assessed sex, age, tumor size, clinical T and N stage, circumferential extension, invasion of anal margin, HIV status, type of chemotherapy, and type of radiotherapy and dose delivered.

The research team evaluated 105 patients treated between 2000 and 2010 met the eligibility criteria.

Median follow-up was 54 months.

Early severe local toxicities occurred in 31% of patients
Diseases of the Colon & Rectum

Early and late severe local toxicities occurred in 31% of patients, and 17% of patients, respectively.

The 5-year cumulative rate of colostomy was 26.6%. Predictive factors for local severe early toxicities included clinical stage III/IV, no brachytherapy boost, and use of chemotherapy.

Only brachytherapy retained its independence in multivariate analysis.

The researchers noted that human immunodeficiency virus positivity was the only predictive factor for late toxicities in univariate analysis.

It was linked independently to the occurrence of ulcer.

The team found that tumor size of 4 cm or more, and occurrence of grade 2 to 3 ulcers were correlated with greater cumulative colostomy incidence.

Dr Doyen's team concludes, "In this cohort, nonuse of brachytherapy was an independent predictive factor for local acute toxicity."

"Human immunodeficiency virus positivity was the only predictive factor for local late toxicities and strongly influenced the onset of ulcer."

Dis Colon Rectum 2013: 56(10): 1125–1133
16 October 2013

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