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1. Crane CH, Skibber JM, Birnbaum EH, Feig BW, Singh AK, Delclos ME, Lin EH, Fleshman JW, Thames HD, Kodner IJ, Lockett MA, Picus J, Phan T, Chandra A, Janjan NA, Read TE, Myerson RJ: The addition of continuous infusion 5-FU to preoperative radiation therapy increases tumor response, leading to increased sphincter preservation in locally advanced rectal cancer. Int J Radiat Oncol Biol Phys; 2003 Sep 1;57(1):84-9
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  • [Title] The addition of continuous infusion 5-FU to preoperative radiation therapy increases tumor response, leading to increased sphincter preservation in locally advanced rectal cancer.
  • PURPOSE: To compare the outcome from preoperative chemoradiation (CXRT) and from radiation therapy (RT) in the treatment of rectal cancer in two large, single-institutional experiences.
  • PATIENTS AND METHODS: Between 1978 and 1995, 403 patients with localized, nonmetastatic, clinically staged T3 or T4 rectal cancer patients were treated with preoperative RT alone at two institutions.
  • Both institutions delivered 45 Gy in five fractions as a standard dose, but institution 2 used 20 Gy in five fractions in selected cases (n = 26).
  • At both institutions, concurrent chemotherapy consisted of a continuous infusion of 5-fluorouracil (5-FU) at a dosage of 1500 mg/m(2)/week.
  • Multivariate analysis of the patients in these groups showed that the use of concurrent chemotherapy improved tumor response (T-stage downstaging, 62% vs. 42%, p = 0.001, and pathologic complete response, 23% vs. 5% p < 0.0001), but did not significantly improve LC, RFS, or OS.
  • In the subset of patients receiving 45 Gy who had rectal tumors < or /=6 cm from the anal verge (institution 1: n = 132; institution 2 primary: n = 79; institution 2 secondary: n = 33), there was a significant improvement in SP with the use of concurrent chemotherapy (39% at institution 1 compared with 13% in the primary group at institution 2, p < 0.0001).
  • A logistic regression analysis of clinical prognostic factors indicated that the use of concurrent chemotherapy independently influenced SP in these low tumors (p = 0.002).
  • Thus SP increased after the addition of chemotherapy at institution 2.
  • CONCLUSIONS: The use of concurrent 5-FU with preoperative radiation therapy for T3 and T4 rectal cancer independently increases tumor response and may contribute to increased SP in patients with low rectal cancer.
  • [MeSH-major] Fluorouracil / administration & dosage. Preoperative Care / methods. Radiotherapy / methods. Rectal Neoplasms / therapy
  • [MeSH-minor] Academic Medical Centers. Adenocarcinoma / drug therapy. Adenocarcinoma / epidemiology. Adenocarcinoma / radiotherapy. Adenocarcinoma / surgery. Adult. Aged. Aged, 80 and over. Anal Canal / radiation effects. Chemotherapy, Adjuvant / methods. Female. Follow-Up Studies. Humans. Infusions, Intravenous. Male. Middle Aged. Radiotherapy, Adjuvant / methods. Retrospective Studies. Texas / epidemiology. Treatment Outcome. Washington / epidemiology

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  • [CommentIn] Int J Radiat Oncol Biol Phys. 2004 Jun 1;59(2):618; author reply 618 [15145184.001]
  • (PMID = 12909219.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / P01-CA16672; United States / NCI NIH HHS / CA / P30CA16672; United States / NCI NIH HHS / CA / T32CA77050
  • [Publication-type] Comparative Study; Journal Article; Multicenter Study; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] U3P01618RT / Fluorouracil
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2. Deniaud-Alexandre E, Touboul E, Tiret E, Sezeur A, Hannoun L, Houry S, Huguet F, Pène F, Parc R, Schlienger M: [Epidermoid carcinomas of anal canal treated with radiation therapy and concomitant chemotherapy (5-fluorouracil and cisplatin)]. Cancer Radiother; 2006 Dec;10(8):572-82
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  • [Title] [Epidermoid carcinomas of anal canal treated with radiation therapy and concomitant chemotherapy (5-fluorouracil and cisplatin)].
  • [Transliterated title] Carcinomes épidermoïdes du canal anal traités par association concomitante de radiothérapie et de chimiothérapie. Evaluation des résultats fonctionnels.
  • PURPOSE: To evaluate our results after radiation therapy and concomitant chemotherapy in terms of local control, survival and toxicity in patients with anal cancer.
  • METHODS AND PATIENTS: Between November 1990 and January 2002, 60 patients (pts) were treated with radiation therapy and concomitant chemotherapy.
  • The T-stage according to the 2001 UICC classification were: 2 T1, 26 T2, 25 T3, and 7 T4.
  • The treatment started with external beam RT (median dose: 45 Gy) and concomitant chemotherapy using 5-fluorouracil and cisplatin during the first week and the fifth week of external beam RT (EBRT).
  • After a rest period of 4 to 6 weeks, a boost of 20 Gy was delivered by EBRT in 58 pts and by interstitial (192)Ir brachytherapy in 2 pts.
  • RESULTS: At the end of RT with concomitant chemotherapy local tumor clinical complete response rate was 83%.
  • The overall local tumor control (LC) rate with or without salvage local treatment were 88%.
  • LC rate with a good anal function scoring (score 0 and 1) was 70%.
  • Among 43 pts who preserved their anus, 98% had a good anal function scoring.
  • Late severe complication was observed in 3 pts: 2 pts with painful necrosis of the anus requiring colostomy and 1 pt with grade 3 rectal bleeding.
  • CONCLUSION: We confirm the good results with RT and concomitant chemotherapy.
  • The clinical tumor response after the first course of RT and concomitant chemotherapy is probably the most important predictive factor on the disease-free survival.
  • For patients with T3 or T4 lesion and tumor regression <or=50% after the first course of radiation therapy, surgical non conservative treatment should be discussed.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Anus Neoplasms / drug therapy. Anus Neoplasms / radiotherapy. Carcinoma, Squamous Cell / drug therapy. Carcinoma, Squamous Cell / radiotherapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Anal Canal / pathology. Antimetabolites, Antineoplastic / administration & dosage. Brachytherapy. Cisplatin / administration & dosage. Combined Modality Therapy. Disease-Free Survival. Female. Fluorouracil / administration & dosage. Follow-Up Studies. HIV Seropositivity. Humans. Lymphatic Metastasis. Male. Middle Aged. Multivariate Analysis. Neoplasm Recurrence, Local. Neoplasm Staging. Prognosis. Radiotherapy Dosage. Time Factors. Treatment Outcome

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  • (PMID = 17110148.001).
  • [ISSN] 1278-3218
  • [Journal-full-title] Cancer radiothérapie : journal de la Société française de radiothérapie oncologique
  • [ISO-abbreviation] Cancer Radiother
  • [Language] fre
  • [Publication-type] Comparative Study; English Abstract; Evaluation Studies; Journal Article
  • [Publication-country] France
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; Q20Q21Q62J / Cisplatin; U3P01618RT / Fluorouracil
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3. Giovannini M, Bardou VJ, Barclay R, Palazzo L, Roseau G, Helbert T, Burtin P, Bouché O, Pujol B, Favre O: Anal carcinoma: prognostic value of endorectal ultrasound (ERUS). Results of a prospective multicenter study. Endoscopy; 2001 Mar;33(3):231-6
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  • [Title] Anal carcinoma: prognostic value of endorectal ultrasound (ERUS). Results of a prospective multicenter study.
  • BACKGROUND AND STUDY AIMS: The classification of anal carcinoma is based on the clinical examination and the estimation of the tumor height (Union Internationale Contre le Cancer (UICC) 1987 Classification).
  • This classification has a direct therapeutic application since tumors which are designated T1 and T2 are generally treated by radiotherapy whereas T3, T4 or N+ lesions are treated by concomitant radiation and chemotherapy.
  • The ERUS classification incorporates disease of the anal canal and the perirectal lymph nodes, thus: usT1 describes involvement of the mucosa and submucosa with sparing of the internal sphincter; usT2, involvement of the internal sphincter with sparing of the external sphincter; usT3, involvement of the external sphincter; usT4, involvement of a pelvic organ; N0 describes no suspicious perirectal lymph nodes, and N+, perirectal lymph nodes fulfilling endosonographic criteria for malignancy (e.g. round, hypoechoic).
  • RESULTS: Data concerning the treatment and follow-up were available for 115/146 patients (78.7%).
  • We compared the prognostic importance of the two classification schemes for treatment response and the rate of local relapse (chi-squared test).
  • A significantly greater proportion of T1-T2N0 lesions classified by ERUS had a complete response to treatment than those classified by conventional UICC staging (94.5% vs. 80%, respectively; P = 0.008).
  • The ERUS T and N stage were significant predictors of relapse (P=0.001 and P=0.03, respectively) whereas the corresponding clinical (UICC) stages were not (P = 0.4 and P = 0.5, respectively).
  • Using a Cox model, usT stage was the only significant predictive factor for patient survival.
  • [MeSH-major] Anus Neoplasms / ultrasonography. Carcinoma, Squamous Cell / ultrasonography. Endosonography

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  • (PMID = 11293755.001).
  • [ISSN] 0013-726X
  • [Journal-full-title] Endoscopy
  • [ISO-abbreviation] Endoscopy
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study
  • [Publication-country] Germany
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4. Huh JW, Jung EJ, Park YA, Lee KY, Sohn SK: Sphincter-preserving operations following preoperative chemoradiation: an alternative to abdominoperineal resection for lower rectal cancer? World J Surg; 2008 Jun;32(6):1116-23
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  • [Title] Sphincter-preserving operations following preoperative chemoradiation: an alternative to abdominoperineal resection for lower rectal cancer?
  • BACKGROUND: Sphincter-preserving operations (SPO) for lower rectal cancer are on the rise.
  • In the study reported here, we compared the oncologic outcomes of patients who underwent sphincter-preserving operations following preoperative chemoradiation for lower rectal cancer with the outcome for patients who underwent abdominoperineal resection (APR).
  • METHODS: This prospective study included 87 patients who underwent proctectomy with curative intent for locally advanced rectal cancer that was located less than 6 cm from the anal verge.
  • Forty-four patients had APR with no preoperative treatment.
  • Forty-three patients underwent concurrent chemoradiation therapy (CCRT) consisting of preoperative 5-fluorouracil-based chemotherapy and pelvic radiation (4500-5040 cGy); this was followed 6 weeks later by surgery (SPO/CCRT).
  • By multivariate analysis, only the pathologic N stage was significantly associated with overall survival (p < 0.001).
  • CONCLUSIONS: Sphincter-preserving operation with CCRT could be another option for the treatment of locally advanced lower rectal cancer in patients who are clinically considered for APR, with no deterioration of oncologic outcomes.
  • For patients undergoing curative resection for lower rectal cancer, the pathologic N stage can provide valuable prognostic information about survival.
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Anal Canal / surgery. Female. Humans. Male. Middle Aged. Neoadjuvant Therapy. Prospective Studies. Survival Analysis. Treatment Outcome

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  • (PMID = 18330627.001).
  • [ISSN] 0364-2313
  • [Journal-full-title] World journal of surgery
  • [ISO-abbreviation] World J Surg
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; U3P01618RT / Fluorouracil
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5. Chauveinc L, Buthaud X, Falcou MC, Mosseri V, De la Rochefordière A, Pierga JY, Girodet J, Salmon RJ: Anal canal cancer treatment: practical limitations of routine prescription of concurrent chemotherapy and radiotherapy. Br J Cancer; 2003 Dec 1;89(11):2057-61
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Anal canal cancer treatment: practical limitations of routine prescription of concurrent chemotherapy and radiotherapy.
  • This study is an analysis of the criteria considered when prescribing concomitant chemotherapy and radiotherapy, as a routine treatment for patients with anal canal cancer, and related complications.
  • Between 1990 and 1996, 67 patients were treated at Institut Curie for invasive, nonmetastatic cancer of the anal canal.
  • TNM stage distribution was as follows: seven T1, 17 T2, 27 T3, 16 T4, and 22 N+ patients.
  • A total of 29 patients (i.e., five T1/T2, and 24 T3/T4) received concurrent chemotherapy and radiotherapy.
  • Radiotherapy volumes and dose and prescribed dose for chemotherapy were not statistically different from one group of patients to another.
  • Only 55% of T3/T4 patients underwent standard chemoradiation treatment for anal canal cancer.
  • Age was the one of main factor in determining if the patient would undergo concomitant chemotherapy or not.
  • For the T3/T4 patients, concomitant chemotherapy was prescribed to 69% of patients <55 years, 90% of patients between 56 and 64 years, 45% of patients between 65 and 75 years, and 20% of patients over 75 years (P<0.02).
  • The 4 years overall survival rate of T3/T4 patients, who underwent concomitant chemotherapy, was 72%, and that of T3/T4 patient who did not, was 34% (P<0.04).
  • The patients who did not undergo chemotherapy were significantly older.
  • Relapse-free interval of T3/T4 patients was 78% with chemotherapy and 60% without chemotherapy (p=NS).
  • Rates of treatment discontinuation and early toxicity were not statistically different.
  • At 2 years, complications occurred in 39% of patients who had undergone concomitant chemotherapy, and in 20% of patients who had not (p<0.02).
  • In conclusion, although radiotherapy with concomitant chemotherapy is considered the current 'gold-standard' treatment for anal canal cancer, in our daily experience, only 55% of our T3/T4 patients have undergone this treatment.
  • The remainder did not undergo chemotherapy mainly because they were deemed too old.
  • In this series, no increase in local control and cause-specific survival was observed in patients who received concomitant chemotherapy; this may be due to the small number of patients included in the series.
  • The increased rate of late complications observed in patients who received the combined treatment, however, provides evidence that this treatment should be restricted to younger patients without comorbidity and therefore justifies our position.
  • Perhaps reduction of doses of chemotherapy must be discussed for older patients.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Anus Neoplasms / drug therapy. Anus Neoplasms / radiotherapy. Carcinoma / drug therapy. Carcinoma / radiotherapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Cisplatin / administration & dosage. Combined Modality Therapy. Fluorouracil / administration & dosage. Humans. Iridium Radioisotopes. Lymphatic Metastasis. Male. Middle Aged. Radiotherapy Dosage. Survival Rate

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  • (PMID = 14647138.001).
  • [ISSN] 0007-0920
  • [Journal-full-title] British journal of cancer
  • [ISO-abbreviation] Br. J. Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Iridium Radioisotopes; Q20Q21Q62J / Cisplatin; U3P01618RT / Fluorouracil
  • [Other-IDs] NLM/ PMC2376848
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6. Roohipour R, Patil S, Goodman KA, Minsky BD, Wong WD, Guillem JG, Paty PB, Weiser MR, Neuman HB, Shia J, Schrag D, Temple LK: Squamous-cell carcinoma of the anal canal: predictors of treatment outcome. Dis Colon Rectum; 2008 Feb;51(2):147-53
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  • [Title] Squamous-cell carcinoma of the anal canal: predictors of treatment outcome.
  • PURPOSE: The incidence of anal canal squamous-cell carcinoma is increasing.
  • Limited data exist on predictors of treatment failure.
  • This study was designed to identify predictors for relapse/persistence after first-line therapy.
  • METHODS: Using one database, we identified 131 Stages I-III patients treated for primary anal canal squamous-cell carcinoma at our institution from December 1986 to August 2006, with minimum six-month follow-up.
  • Demographic, pathologic, treatment, and outcome data were extracted.
  • Treatment failure was defined as biopsy-proven persistence or relapse (local and/or distant).
  • RESULTS: Of 131 patients (median age, 58.3 years; median follow-up, 2.9 (range, 0.6-11.2) years), 66 percent were females, 43.5 percent were Stage II, and 11 (8 percent) were HIV-positive.
  • Although 114 (93.4 percent) completed radiotherapy, most required treatment breaks, making total duration of radiotherapy longer than planned.
  • Almost all patients undergoing radiotherapy (96.7 percent, 118/122) also had chemotherapy: 118 (100 percent, Stages I-III) had concurrent chemotherapy: (98 (83.8 percent) mitomycin/5-fluorouracil, 12 (10.2 percent) cisplatin/5-fluorouracil, 8 (6.8 percent) 5-fluorouracil alone); 35 of 46 (76 percent) Stage III patients received induction chemotherapy (34 (97.1 percent) cisplatin/5-fluorouracil, 1 (2.8 percent) 5-fluorouracil alone).
  • Many (44 percent Stages I/II, 48.9 percent Stage III) required dose adjustments.
  • Thirty-seven patients (28.2 percent) failed first-line therapy.
  • Bivariate analyses demonstrated that T stage (P=0.0019), completion of radiotherapy, and total radiotherapy dose (P=0.03) were all significantly associated with treatment failure.
  • On multivariate analyses, disease stage (P=0.05) and completion of radiotherapy (P=0.01) remained significant predictors of relapse-free survival.
  • CONCLUSIONS: Tolerance of chemoradiation seems to be an important predictor of treatment success.
  • Effective therapies with less acute toxicity must be identified.
  • [MeSH-major] Anus Neoplasms / therapy. Carcinoma, Squamous Cell / therapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Biopsy. Combined Modality Therapy / methods. Disease-Free Survival. Endosonography. Female. Follow-Up Studies. Humans. Incidence. Male. Middle Aged. Neoplasm Recurrence, Local / epidemiology. Neoplasm Staging. New York / epidemiology. Retrospective Studies. Survival Rate. Time Factors. Tomography, X-Ray Computed. Treatment Outcome

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  • [ErratumIn] Dis Colon Rectum. 2008 May;51(5):620
  • (PMID = 18180997.001).
  • [ISSN] 0012-3706
  • [Journal-full-title] Diseases of the colon and rectum
  • [ISO-abbreviation] Dis. Colon Rectum
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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7. Winburn GB: Anal carcinoma or "just hemorrhoids"? Am Surg; 2001 Nov;67(11):1048-58
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Anal carcinoma or "just hemorrhoids"?
  • Cancers of the anal margin and anal canal are extremely rare and often misdiagnosed.
  • From January 1985 through July 2000, 50 patients were diagnosed with anal cancer at two institutions.
  • This retrospective review includes all available cases of anal cancer including all histologies.
  • Patient charts were analyzed for diagnosis, staging, treatment, survival, and recurrence rate.
  • The pathologic diagnosis included 44 (88%) with squamous cell carcinoma, three (6%) with melanoma, two (4%) with adenocarcinoma, and one (2%) with Paget's disease.
  • At presentation nine (18%) were classified as stage 0, five (10%) stage I, 21 (42%) stage II, eight (16%) stage III, and seven (14%) stage IV.
  • Chemoradiotherapy was the primary treatment modality in 25 patients (50%).
  • Three patients (6%) received an APR as primary treatment, three (6%) in combination with chemoradiation, and four (8%) for salvage therapy.
  • Fourteen patients (28%) underwent wide local excision (WLE) as the primary treatment.
  • Two patients (4%) underwent WLE plus chemoradiation therapy.
  • One patient (2%) underwent WLE and chemotherapy.
  • Thirteen patients (26%) died of anal cancer; the average time to death from diagnosis was 13.2 months.
  • Three of these deaths were in patients with melanoma who presented with stage IV disease.
  • Thirty-two patients (64%) are alive, and 30 (60%) of these patients are free of disease (mean time since diagnosis 32.5 months, range 2-151 months).
  • Six patients (12%) had recurrence after treatment (mean time to recurrence 12.6 months; range 3-26 months).
  • Anal cancers continue to present at an advanced stage, with a high mortality rate.
  • Anal melanoma in particular is an aggressive and highly fatal cancer.
  • APR remains the recommended salvage therapy for advanced anal carcinomas that fail primary treatment.
  • Early recognition and detection of primary and recurrent disease is necessary for improved outcome.
  • [MeSH-major] Anus Neoplasms / diagnosis. Carcinoma, Squamous Cell / diagnosis
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Diagnosis, Differential. Female. Hemorrhoids / diagnosis. Humans. Male. Middle Aged. Neoplasm Staging. Retrospective Studies. Survival Analysis

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  • (PMID = 11730221.001).
  • [ISSN] 0003-1348
  • [Journal-full-title] The American surgeon
  • [ISO-abbreviation] Am Surg
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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8. Moore HG, Gittleman AE, Minsky BD, Wong D, Paty PB, Weiser M, Temple L, Saltz L, Shia J, Guillem JG: Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection. Dis Colon Rectum; 2004 Mar;47(3):279-86
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection.
  • INTRODUCTION: Recent data suggest a favorable prognosis for rectal cancer patients with a pathologic complete response to preoperative combined modality therapy.
  • Prolongation of the interval between preoperative combined modality therapy and surgery (RT-surgery interval) as a means of increasing pathologic complete response rate has not been fully examined.
  • METHODS: One hundred and fifty-five rectal cancer patients undergoing preoperative pelvic external beam radiation therapy and 5-fluorouracil-based chemotherapy followed by rectal resection were identified.
  • All patients had endorectal ultrasound prior to combined modality therapy.
  • Final pathology reports were reviewed for ypT and ypN stage and margin status.
  • Medical records were reviewed for sphincter preservation, operative time, estimated blood loss, hospital stay, and morbidity (overall, anastomotic, and perineal).
  • The rates of sphincter preservation, positive margins, estimated blood loss, and operative time were not significantly different.
  • Until prospective analyses are conducted assessing the impact of prolonged RT-surgery interval on long-term outcome, the benefit of a prolonged interval between the completion of preoperative combined modality therapy and surgery remains unclear.
  • [MeSH-major] Preoperative Care / methods. Rectal Neoplasms / pathology. Rectal Neoplasms / therapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Anal Canal / physiology. Anal Canal / surgery. Antimetabolites, Antineoplastic / therapeutic use. Combined Modality Therapy. Endosonography. Female. Fluorouracil / therapeutic use. Humans. Length of Stay. Male. Middle Aged. Neoplasm Staging. Postoperative Complications. Retrospective Studies. Time Factors

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  • [CommentIn] Dis Colon Rectum. 2005 May;48(5):1097-8; author reply 1098 [15933896.001]
  • (PMID = 14991488.001).
  • [ISSN] 0012-3706
  • [Journal-full-title] Diseases of the colon and rectum
  • [ISO-abbreviation] Dis. Colon Rectum
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / R01 CA 82534-01
  • [Publication-type] Journal Article; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; U3P01618RT / Fluorouracil
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9. Janjan NA, Crane CN, Feig BW, Cleary K, Dubrow R, Curley SA, Ellis LM, Vauthey J, Lenzi R, Lynch P, Wolff R, Brown T, Pazdur R, Abbruzzese J, Hoff PM, Allen P, Brown B, Skibber J: Prospective trial of preoperative concomitant boost radiotherapy with continuous infusion 5-fluorouracil for locally advanced rectal cancer. Int J Radiat Oncol Biol Phys; 2000 Jun 1;47(3):713-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Prospective trial of preoperative concomitant boost radiotherapy with continuous infusion 5-fluorouracil for locally advanced rectal cancer.
  • RATIONALE: To evaluate the response to a concomitant boost given during standard chemoradiation for locally advanced rectal cancer.
  • METHODS AND MATERIALS: Concomitant boost radiotherapy was administered preoperatively to 45 patients with locally advanced rectal cancer in a prospective trial.
  • Treatment consisted of 45 Gy to the pelvis with 18 mV photons at 1.8 Gy/fraction using a 3-field belly board technique with continuous infusion 5FU chemotherapy (300mg/m(2)) 5 days per week.
  • The boost was given during the last week of therapy with a 6-hour inter-fraction interval to the tumor plus a 2-3 cm margin.
  • The boost dose equaled 7.5 Gy/5 fractions (1.5 Gy/fraction); a total dose of 52.5 Gy/5 weeks was given to the primary tumor.
  • Pretreatment tumor stage, determined by endorectal ultrasound and CT scan, included 29 with T3N0 [64%], 11 T3N1, 1 T3Nx, 2 T4N0, 1 T4N3, and 1 with TxN1 disease.
  • Mean distance from the anal verge was 5 cm (range 0-13 cm).
  • Median time of follow-up is 8 months (range 1-24 months).
  • Among the 28 tumors (67%) located <6 cm from the anal verge, SP was accomplished in 21 cases (75%).
  • Compared to our contemporary experience with conventional CTX/XRT (45Gy; 1.8 Gy per fraction), improvements were seen in SP (79% vs. 59%; p = 0.02), SP for tumors <6 cm from the anal verge (75% vs. 42%; p = 0.003), and down-staging (86% vs. 62%; p = 0.003).
  • [MeSH-major] Antimetabolites, Antineoplastic / therapeutic use. Fluorouracil / therapeutic use. Rectal Neoplasms / drug therapy. Rectal Neoplasms / radiotherapy
  • [MeSH-minor] Adult. Aged. Anal Canal / surgery. Combined Modality Therapy. Female. Follow-Up Studies. Humans. Lymphatic Metastasis. Male. Middle Aged. Neoplasm Staging. Prospective Studies. Radiotherapy Dosage

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  • (PMID = 10837955.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / P01CA06294; United States / NCI NIH HHS / CA / P30CA16672; United States / NCI NIH HHS / CA / T32CA77050
  • [Publication-type] Journal Article; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; U3P01618RT / Fluorouracil
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10. Widder J, Kastenberger R, Fercher E, Schmid R, Langendijk JA, Dobrowsky W, Pötter R: Radiation dose associated with local control in advanced anal cancer: retrospective analysis of 129 patients. Radiother Oncol; 2008 Jun;87(3):367-75
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Radiation dose associated with local control in advanced anal cancer: retrospective analysis of 129 patients.
  • BACKGROUND AND PURPOSE: To retrospectively analyse a large consecutive cohort of patients with anal cancer for treatment-related factors influencing local control and survival.
  • MATERIALS AND METHODS: All patients referred for primary radiotherapy at Medical University of Vienna in 1990-2002 with anal canal carcinoma without distant metastases were analysed.
  • Treatment consisted of external radiotherapy with or without brachytherapy and with or without chemotherapy.
  • Patient-, tumour-, and treatment-factors were tested for influence on survival and local control using Cox multivariate analysis.
  • RESULTS: Median age was 67 years (n=129), the UICC stage distribution was 15%, 58%, and 27% for stages I, II, and III, respectively.
  • Stage and age were significant factors for overall and colostomy-free-survival, N-stage for disease-free-survival.
  • Shorter overall treatment time favoured local control in stage T1-2 (p=.015), higher total radiation dose and female gender were associated with improved local control in T3-4 tumours (p=.021).
  • CONCLUSIONS: These results support potential improvement of anal cancer treatment by studying advanced technology such as IMRT, making it possible to tailor high-dose regions.
  • [MeSH-major] Anus Neoplasms / radiotherapy. Carcinoma, Squamous Cell / radiotherapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Combined Modality Therapy. Disease-Free Survival. Female. Humans. Male. Middle Aged. Neoplasm Recurrence, Local. Radiotherapy Dosage. Survival Rate

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  • (PMID = 18501453.001).
  • [ISSN] 0167-8140
  • [Journal-full-title] Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
  • [ISO-abbreviation] Radiother Oncol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Ireland
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11. Deniaud-Alexandre E, Touboul E, Tiret E, Sezeur A, Houry S, Gallot D, Parc R, Huang R, Qu SH, Huart J, Pène F, Schlienger M: Results of definitive irradiation in a series of 305 epidermoid carcinomas of the anal canal. Int J Radiat Oncol Biol Phys; 2003 Aug 1;56(5):1259-73
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  • [Title] Results of definitive irradiation in a series of 305 epidermoid carcinomas of the anal canal.
  • PURPOSE: To evaluate our data concerning the prognostic factors for locoregional control, survival, late complications, and sphincter conservation in a series of epidermoid cancers of the anal canal without clinical evidence of metastasis.
  • The T stage according to the 1987 International Union Against Cancer classification was T1 in 26, T2 in 141, T3 in 104, and T4 in 34.
  • The pretreatment anal function score, according to our in-house system, was 0 for 22 patients, 1 for 182, 2 for 74, 3 for 7, and 4 for 11 patients; for 9 patients, scores were unavailable.
  • The treatment started with external beam radiotherapy (EBRT) in 303 patients (median dose 45 Gy).
  • After a rest period of 4-6 weeks, a boost of 20 Gy was delivered by EBRT in 279 patients and by interstitial (192)Ir brachytherapy in 17 patients.
  • Seven patients received only one course of EBRT (mean dose 49.5 Gy), and 2 patients were treated with interstitial (192)Ir brachytherapy alone (55 Gy and 60 Gy).
  • Concomitant chemotherapy (5-fluorouracil and either mitomycin C or cisplatin) was delivered to 19 patients.
  • The overall local control rate (with or without salvage local therapy) was 84%.
  • The local control rate with good anal function (score 0 or 1) was 56.5%.
  • Of 181 available patients with their anus preserved, 94% had good anal function.
  • For a subgroup of 15 patients with a tumor length of <2 cm and without nodal involvement, the clinical complete response rate after RT completion was 100%, the local control rate with or without local salvage treatment was 100%, and among 13 available patients with their anus preserved, the anal function score was good in 12 patients (92%).
  • After multivariate analysis, three independent predictive factors significantly influenced disease-free survival: the interval between the two courses of RT (>38 days vs. < or =38 days, p = 0.0025), pretreatment anal function score (0 vs. 1 vs. 2 vs. 3 vs. 4, p = 4.4.10(-6)), and clinical complete response after RT completion (no complete response vs. complete response, p = 2.5.10(-14)).
  • However, to improve survival without colostomy with good anal sphincter function, chemoradiotherapy should be preferred for tumors > or =2 cm in length and for locally advanced tumors.
  • [MeSH-major] Anus Neoplasms / radiotherapy. Carcinoma, Squamous Cell / radiotherapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Anal Canal / physiopathology. Female. Humans. Male. Middle Aged. Neoplasm Metastasis. Survival Rate. Treatment Failure

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  • (PMID = 12873670.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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12. Kim CW, Kim JH, Yu CS, Shin US, Park JS, Jung KY, Kim TW, Yoon SN, Lim SB, Kim JC: Complications after sphincter-saving resection in rectal cancer patients according to whether chemoradiotherapy is performed before or after surgery. Int J Radiat Oncol Biol Phys; 2010 Sep 1;78(1):156-63
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Complications after sphincter-saving resection in rectal cancer patients according to whether chemoradiotherapy is performed before or after surgery.
  • PURPOSE: The aim of the present study was to compare the influence of preoperative chemoradiotherapy (CRT) with postoperative CRT on the incidence and types of postoperative complications in rectal cancer patients who underwent sphincter-saving resection.
  • RESULTS: There was no between-group difference in age, gender, or cancer stage.
  • In the pre-CRT group, the mean level of anastomosis from the anal verge was lower (3.5 +/- 1.4 cm vs. 4.3 +/- 1.7 cm, p < 0.001) and the rate of T4 lesion and temporary diverting ileostomy was higher than in the post-CRT group.
  • Delayed anastomotic leakage and rectovaginal fistulae developed more frequently in the pre-CRT group than in the post-CRT group (3.9% vs. 1.2%, p = 0.020, 6.5% vs. 1.3%, p = 0.027, respectively).
  • [MeSH-major] Adenocarcinoma. Anal Canal / surgery. Neoadjuvant Therapy / methods. Postoperative Complications / etiology. Rectal Neoplasms
  • [MeSH-minor] Adult. Aged. Anastomosis, Surgical. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Capecitabine. Deoxycytidine / administration & dosage. Deoxycytidine / analogs & derivatives. Drug Administration Schedule. Enteritis / etiology. Enteritis / surgery. Female. Fluorouracil / administration & dosage. Fluorouracil / analogs & derivatives. Humans. Ileostomy / statistics & numerical data. Intestinal Obstruction / etiology. Intestinal Obstruction / surgery. Korea. Leucovorin / administration & dosage. Male. Middle Aged. Multivariate Analysis. Preoperative Care. Radiotherapy Dosage. Rectal Fistula / etiology. Rectal Fistula / surgery. Rectovaginal Fistula / etiology. Rectovaginal Fistula / therapy. Rectum / surgery. Urinary Bladder Fistula / etiology. Urinary Bladder Fistula / surgery. Young Adult

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  • [Copyright] Copyright (c) 2010 Elsevier Inc. All rights reserved.
  • (PMID = 20106604.001).
  • [ISSN] 1879-355X
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0W860991D6 / Deoxycytidine; 6804DJ8Z9U / Capecitabine; Q573I9DVLP / Leucovorin; U3P01618RT / Fluorouracil
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13. Ferrigno R, Nakamura RA, Dos Santos Novaes PE, Pellizzon AC, Maia MA, Fogarolli RC, Salvajoli JV, Filho WJ, Lopes A: Radiochemotherapy in the conservative treatment of anal canal carcinoma: retrospective analysis of results and radiation dose effectiveness. Int J Radiat Oncol Biol Phys; 2005 Mar 15;61(4):1136-42
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Radiochemotherapy in the conservative treatment of anal canal carcinoma: retrospective analysis of results and radiation dose effectiveness.
  • PURPOSE: This retrospective analysis reports the results on patients with anal canal carcinoma treated by combined radiotherapy and chemotherapy.
  • METHODS AND MATERIALS: Between March 1993 and December 2001, 43 patients with anal canal carcinoma were treated with radiochemotherapy at the Hospital do Cancer A.C. Camargo.
  • Stage distribution was as follows: I, 3 (7%); II, 23 (53.5%); IIIA, 8 (18.6%); and IIIB, 9 (21%).
  • The median dose of RT at the whole pelvis and at the primary tumor was 45 Gy and 55 Gy, respectively.
  • Chemotherapy was carried out during the first and last 4 days of RT with continuous infusion of 5-fluorouracil (1000 mg/m(2)) and bolus mitomycin C (10 mg/m(2)).
  • Median overall treatment time was 51 days (range, 30-129 days).
  • Patient's age, tumor stage, overall treatment time, and RT dose at primary tumor were variables analyzed for survival and local control.
  • RESULTS: Median follow-up time was 42 months (range, 4-116 months).
  • Overall survival according to clinical stage was as follows: I, 100%; II, 82%; IIIA, 73%; and IIIB, 18% (p = 0.0049).
  • According to the RT dose, local control was higher among patients who received more than 50 Gy at primary tumor (86.5% vs. 34%, p = 0.012).
  • Temporary interruption of the treatment as a result of acute toxicity was necessary in 12 patients (28%).
  • Four patients developed mild chronic complications.
  • CONCLUSIONS: This analysis suggests that the treatment scheme employed was effective for anal sphincter preservation and local control; however, the incidence of distant metastases was relatively high.
  • The clinical stage was the main prognostic factor for overall survival.
  • Local control was higher in patients treated with doses of more than 50 Gy at primary tumor.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Anus Neoplasms / drug therapy. Anus Neoplasms / radiotherapy. Carcinoma, Squamous Cell / drug therapy. Carcinoma, Squamous Cell / radiotherapy
  • [MeSH-minor] Adult. Aged. Combined Modality Therapy. Female. Fluorouracil / administration & dosage. Humans. Male. Middle Aged. Mitomycin / administration & dosage. Neoplasm Recurrence, Local / surgery. Radiotherapy Dosage. Retrospective Studies. Treatment Outcome

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  • (PMID = 15752894.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Publication-type] Evaluation Studies; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 50SG953SK6 / Mitomycin; U3P01618RT / Fluorouracil
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14. Kiran RP, Pokala N, Rottoli M, Fazio VW: Is survival reduced for patients with anal cancer requiring surgery after failure of radiation? Analysis from a population study over two decades. Am Surg; 2009 Feb;75(2):163-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Is survival reduced for patients with anal cancer requiring surgery after failure of radiation? Analysis from a population study over two decades.
  • Chemoradiotherapy is the standard treatment for anal cancer.
  • Surgery is reserved for failure of therapy, but there are limited data examining outcomes after surgery.
  • From a prospective population-based database on radiation and surgical therapy, we compare outcomes for patients with anal cancer undergoing rectal resection after radiation with patients undergoing radiation alone.
  • Patients undergoing surgical resection of the rectum after initial radiation (SRT) for squamous cell carcinoma of the anus, anal canal, cloacogenic zone, and overlapping lesions of the rectum and anal canal from 1983 to 2002 were identified from the Surveillance, Epidemiology and End Results database.
  • SRT had more patients with regional stage of disease (66.7 vs 42.4%, P = 0.001).
  • For patients with localized stage, survival for SRT and RT was similar (105 vs 98 months, P = 0.7).
  • For patients with regional stage, survival for SRT and RT was similar (95 vs 83 months, P = 0.6).
  • Because radiation is combined with chemotherapy, this suggests that salvage surgery after failure of therapy results in outcomes comparable to combination therapy alone.
  • [MeSH-major] Anus Neoplasms / mortality. Anus Neoplasms / surgery. Carcinoma, Squamous Cell / mortality. Carcinoma, Squamous Cell / surgery
  • [MeSH-minor] Adult. Aged. Female. Humans. Male. Middle Aged. Radiotherapy, Adjuvant. Retrospective Studies. SEER Program. Survival Rate. Treatment Failure. United States / epidemiology

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  • (PMID = 19280811.001).
  • [ISSN] 0003-1348
  • [Journal-full-title] The American surgeon
  • [ISO-abbreviation] Am Surg
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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15. Staib L, Gottwald T, Lehnert T, Ruf G, Sturm J, Becker HD, Farthmann E, Herfarth C, Post S, Trede M, Beger HG: Sphincter-saving treatment in epidermoid anal cancer: cooperative analysis of 142 patients in five German university surgical centers. Int J Colorectal Dis; 2000 Nov;15(5-6):282-90
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Sphincter-saving treatment in epidermoid anal cancer: cooperative analysis of 142 patients in five German university surgical centers.
  • Five southern German university centers cooperated in comparing the effect of surgical vs. nonsurgical therapy strategies on survival and sphincter preservation in the treatment of anal cancer.
  • A standardized questionnaire was used to evaluate retrospectively (mean follow-up 30 months) treatment strategy and outcome (survival, colostomy rate, colostomy-free survival) in patients treated between 1987 and 1996.
  • Of the 142 patients 65% had squamous cell, 20% basaloid, 6% adeno-, and 1% undifferentiated carcinoma (8% histology not recorded); 9% were classified in UICC stage I, 37% in stage II, 25% in stage III, and 4% in stage IV (25% not recorded).
  • Primary treatment consisted of local excision (10%), excision plus radio- and/or chemotherapy (17%), radiotherapy (20%), radiochemotherapy (28%), or colostomy with or without resection, radiotherapy, and chemotherapy (23%).
  • We observed no difference between these treatment groups in overall (P = 0.43) or colostomy-free survival (P = 0.14, log-rank).
  • Mean overall survival (in months) was 42 in stage I, 38 in stage II, and 25 in stage III (P = 0.0013); mean colostomy-free survival was 36 in stage I, 26 in stage II, and 16 in stage III (P = 0.0021, log-rank).
  • Outcome was not significantly related to therapeutic strategy (surgery or radio-chemotherapy.
  • Primary surgical and nonsurgical strategies in treating anal cancer thus produced similar results, although radiochemotherapy is usually recommended for sphincter-endangering anal cancer.
  • Challenges to be met in the future include the prevention of metastasis and long-term preservation of anal sphincter function.
  • [MeSH-major] Anal Canal / surgery. Anus Neoplasms / surgery. Carcinoma, Squamous Cell / surgery
  • [MeSH-minor] Adenocarcinoma / mortality. Adenocarcinoma / surgery. Adenocarcinoma / therapy. Adult. Aged. Aged, 80 and over. Carcinoma / mortality. Carcinoma / surgery. Carcinoma / therapy. Clinical Trials as Topic. Disease-Free Survival. Female. Humans. Male. Middle Aged. Multicenter Studies as Topic. Time Factors. Treatment Outcome


16. Gonzalez QH, Heslin MJ, Shore G, Vickers SM, Urist MM, Bland KI: Results of long-term follow-up for transanal excision for rectal cancer. Am Surg; 2003 Aug;69(8):675-8; discussion 678
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  • [Title] Results of long-term follow-up for transanal excision for rectal cancer.
  • Low anterior resection and abdominoperineal resection are the surgical techniques used most frequently in the treatment of rectal cancer.
  • It is our hypothesis that selected patients with early T stage, well or moderate grade of differentiation, and small tumor size are good candidates for transanal excision in terms of minimal morbidity, low recurrence rate, and sphincter preservation.
  • Factors analyzed included those related to the patient [age (years), gender, race, body mass index, and anal tone], tumor [size (cm), distance from the anal verge (cm), differentiation, and American Joint Committee on Cancer stage], and additional treatment.
  • Preoperatively 81, 11, and 4 per cent of the patients had stage I, II, and III/IV cancer, respectively.
  • Preoperative size of the tumor was 2.0 cm (1-3 cm), and distance from the anal verge was 5.0 cm (3-15 cm).
  • Additional treatment consisted of radiation therapy in seven patients (six postoperative and one preoperative).
  • Chemotherapy was given to seven patients (six postoperative and one preoperative).
  • Transanal excision of low rectal cancer in selected patients is an acceptable alternative to formal resection.
  • Important selection criteria include early T stage, well or moderate differentiation, relatively small tumor size, and negative microscopic margins.
  • The roles of radiation and chemotherapy remain controversial.
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Anal Canal / surgery. Chemotherapy, Adjuvant. Follow-Up Studies. Humans. Lymphatic Metastasis. Middle Aged. Neoplasm Invasiveness. Neoplasm Recurrence, Local. Neoplasm Staging. Radiotherapy, Adjuvant

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  • (PMID = 12953825.001).
  • [ISSN] 0003-1348
  • [Journal-full-title] The American surgeon
  • [ISO-abbreviation] Am Surg
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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17. Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, Halverson AL: Squamous cell carcinoma of the anal canal: utilization and outcomes of recommended treatment in the United States. Ann Surg Oncol; 2008 Jul;15(7):1948-58
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Squamous cell carcinoma of the anal canal: utilization and outcomes of recommended treatment in the United States.
  • BACKGROUND: Over the past two decades, recommended treatment for squamous cell carcinoma of the anal canal has shifted from surgery to primary chemoradiation.
  • Our objectives were (1) to evaluate treatment trends over the past 20 years, (2) to assess contemporary treatment utilization, and (3) to examine the impact of recommended vs nonguideline treatment on survival.
  • METHODS: From the National Cancer Data Base (1985-2005), 38,882 patients with anal canal cancer were identified.
  • Regression models were used to assess factors associated with use of nonguideline treatment (vs chemoradiation +/-surgery).
  • Univariate and multivariate methods were used to assess the impact of treatment on survival.
  • RESULTS: From 1985 to 2005, the use of chemoradiation increased significantly with a concomitant decrease in treatment with surgery alone (P < .0001).
  • However, only 74.9% (5014 of 6696) of patients underwent primary chemoradiation therapy in 2003-2005.
  • Overall, 22.7% (1523 of 6696) of patients received treatment that was not concordant with established guidelines: primary surgery (13.0%) and primary chemotherapy or radiation (9.7%).
  • Patients were significantly less likely to receive guideline treatment if male, older, black or Hispanic, more severe comorbidities, or Stage I (vs Stage II or III).
  • Patients undergoing chemoradiation ( +/- surgery) had higher 5-year survival rates than patients who received nonguideline treatment (64% vs 58%; hazard ratio 0.82, 95% confidence interval [95% CI] 0.77-0.87; P < .0001).
  • CONCLUSION: Primary chemoradiation therapy has supplanted surgical treatment and is associated with better outcomes; however, nearly a quarter of patients are still receiving treatment that is not concordant with established guidelines.
  • [MeSH-major] Anus Neoplasms / therapy. Neoplasms, Squamous Cell / therapy
  • [MeSH-minor] Aged. Aged, 80 and over. Combined Modality Therapy. Female. Guideline Adherence. Humans. Male. Neoplasm Staging. Survival Rate. Treatment Outcome. United States

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  • (PMID = 18414951.001).
  • [ISSN] 1534-4681
  • [Journal-full-title] Annals of surgical oncology
  • [ISO-abbreviation] Ann. Surg. Oncol.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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18. Weber DC, Kurtz JM, Allal AS: The impact of gap duration on local control in anal canal carcinoma treated by split-course radiotherapy and concomitant chemotherapy. Int J Radiat Oncol Biol Phys; 2001 Jul 1;50(3):675-80
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] The impact of gap duration on local control in anal canal carcinoma treated by split-course radiotherapy and concomitant chemotherapy.
  • PURPOSE: To investigate the potential benefit of reducing the intersequence gap in patients with anal cancer treated with split-course chemoradiotherapy.
  • METHODS: The study group consisted of 90 patients with anal squamous carcinoma treated between 1981 and 1998, using concomitant chemotherapy (CT) and radiation (RT).
  • First (pelvic) sequence delivered a median dose of 40 Gy (range 36-50.4), using AP/PA megavoltage photon beams.
  • Boost treatment (median dose 20 Gy, range 13-26) consisted of either Iridium-192 implantation (49 patients) or external beam RT (41 patients).
  • Number of CT cycles (1 vs. 2 or more), boost technique (brachytherapy vs. external), and T-stage were not significantly associated with LRC.
  • CONCLUSION: In anal cancers, split-course RT with > 50 Gy dose delivery is difficult to avoid because of acute toxicity.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Anus Neoplasms / drug therapy. Anus Neoplasms / radiotherapy. Carcinoma, Squamous Cell / drug therapy. Carcinoma, Squamous Cell / radiotherapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Combined Modality Therapy. Dose Fractionation. Female. Fluorouracil / administration & dosage. Humans. Male. Middle Aged. Mitomycin / administration & dosage. Multivariate Analysis. Retrospective Studies. Time Factors

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  • (PMID = 11395235.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 50SG953SK6 / Mitomycin; U3P01618RT / Fluorouracil
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19. Fritzmann J, Hünerbein M, Slisow W, Gellermann J, Wust P, Rau B: [Influence of preoperative (hyperthermic) radiochemotherapy on manometric anal sphincter function in locally advanced rectal cancer]. Strahlenther Onkol; 2004 May;180(5):281-8
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  • [Title] [Influence of preoperative (hyperthermic) radiochemotherapy on manometric anal sphincter function in locally advanced rectal cancer].
  • BACKGROUND AND PURPOSE: Preoperative radiochemotherapy (RCT) followed by curative surgery is a well-accepted therapeutic option in the treatment of advanced rectal cancer.
  • Usually, the anal sphincter is located in the irradiation area of a preoperative RCT regime.
  • The aim of this study is to evaluate the influence of preoperative RCT on anal sphincter function.
  • PATIENTS AND METHODS: Between 1994 and 2000, 102 patients with rectal cancer stage uT3/uT4 were analyzed.
  • All patients underwent radiotherapy with 45 Gy (5 x 1.8 Gy) including two cycles of 5-fluorouracil (5-FU)/leucovorin (folinic acid) chemotherapy.
  • The sphincter function was analyzed by perfusion manometry before preoperative therapy and 4 weeks after pretreatment had been finished.
  • For patients with distal (</= 7.5 cm from anal verge) tumors the difference was highly significant (92 vs. 79 mmHg).
  • CONCLUSION: Preoperative RCT impairs sphincter function especially in patients with distal tumors.
  • [MeSH-major] Anal Canal / physiopathology. Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Preoperative Care / methods. Rectal Neoplasms / drug therapy. Rectal Neoplasms / radiotherapy
  • [MeSH-minor] Combined Modality Therapy / methods. Female. Fluorouracil / administration & dosage. Humans. Hyperthermia, Induced / methods. International Cooperation. Leucovorin / administration & dosage. Male. Manometry. Middle Aged. Treatment Outcome

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  • (PMID = 15127158.001).
  • [ISSN] 0179-7158
  • [Journal-full-title] Strahlentherapie und Onkologie : Organ der Deutschen Röntgengesellschaft ... [et al]
  • [ISO-abbreviation] Strahlenther Onkol
  • [Language] ger
  • [Publication-type] Clinical Trial; English Abstract; Journal Article
  • [Publication-country] Germany
  • [Chemical-registry-number] Q573I9DVLP / Leucovorin; U3P01618RT / Fluorouracil
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20. Vuong T, Kopek N, Ducruet T, Portelance L, Faria S, Bahoric B, Devic S: Conformal therapy improves the therapeutic index of patients with anal canal cancer treated with combined chemotherapy and external beam radiotherapy. Int J Radiat Oncol Biol Phys; 2007 Apr 1;67(5):1394-400
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  • [Title] Conformal therapy improves the therapeutic index of patients with anal canal cancer treated with combined chemotherapy and external beam radiotherapy.
  • PURPOSE: To evaluate the clinical outcomes of three-dimensional conformal radiotherapy (3D-CRT) in patients with anal canal cancer, in terms of local control (LC), freedom from relapse (FFR), and overall survival (OS) rates, and to estimate long-term toxicity data.
  • Patients treated with 3D-CRT received 54 Gy in 30 fractions delivered continuously, compared with 45-58.9 Gy (median dose, 54 Gy) in a split course in patients treated with C-RT.
  • Chemotherapy consisted of 5-fluorouracil with either mitomycin-C or cis-platinum given concurrently with radiation.
  • RESULTS: No differences in stage and age distribution were observed between the two groups.
  • CONCLUSION: The use of 3D-CRT allows patients with anal canal cancer to complete radiation and chemotherapy without interruption for toxicity, with significant improvements in LC, FFR, and OS.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Anus Neoplasms / drug therapy. Anus Neoplasms / radiotherapy. Radiotherapy, Conformal
  • [MeSH-minor] Aged. Cisplatin / administration & dosage. Combined Modality Therapy / methods. Female. Fluorouracil / administration & dosage. Humans. Male. Middle Aged. Mitomycin / administration & dosage. Proportional Hazards Models. Radiotherapy Dosage. Survival Analysis

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  • (PMID = 17276620.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 50SG953SK6 / Mitomycin; Q20Q21Q62J / Cisplatin; U3P01618RT / Fluorouracil
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21. Kim KJ, Kim JH, Choi EK, Ahn SD, Lee SW, Kim JC, Yu CS, Kim HC, Lee JH, Kim TW: Patterns of Failure and Prognostic Factors in Anal Cancer Treated with Radiotherapy. Cancer Res Treat; 2003 Apr;35(2):141-7
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Patterns of Failure and Prognostic Factors in Anal Cancer Treated with Radiotherapy.
  • PURPOSE: To analyze the patterns of failure and prognostic factors affecting the local control and survivals in anal cancer treated with definitive radiotherapy, and to find the most effective treatment modality.
  • MATERIALS AND METHODS: Thirty consecutive patients, with primary cancers of the anal canal, were treated using radiotherapy, both with and without 5-FU based concurrent chemotherapy.
  • According to the AJCC tumor stage, six patients hadwere stage I, 11 had stage II, 2 had stage IIIA, and 11 had stage IIIB tumors.
  • The median radiation dose was 45 Gy (30-72 Gy), and with 23 patients receivinged concurrent chemotherapy (5-FU and mitomycin C in 12 patients, 5-FU and cisplatin in 7, and other drugs in 4).
  • The factors which affectinged the 5 year local relapse free survival were T-stage (74.9% in T1-2 vs. 28.6% in T3-4, p=0.01), and the existence of a gross tumor beforeprior to radiotherapy (84.6%, no residual vs. 45.1% with residual, p=0.03).
  • CONCLUSION: A Llocal recurrence was the major failure pattern in anal cancers, and the factors affecting a local failure were the T-stage and tumor volume beforeprior to radiotherapy.
  • A Rradiation dose around 45 Gy was sufficient to control tumors of the earlier T stage tumors, but a higher dose should be considered for with more advanced lesions.

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  • (PMID = 26680928.001).
  • [ISSN] 1598-2998
  • [Journal-full-title] Cancer research and treatment : official journal of Korean Cancer Association
  • [ISO-abbreviation] Cancer Res Treat
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Korea (South)
  • [Keywords] NOTNLM ; Anal neoplasm / Patterns of failure / Radiotherapy
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