Treatment of anal carcinoma in the elderly - Feasibility and outcome of radical radiotherapy with or without concomitant chemotherapy

BACKGROUND, For most cancers, information on treatment tolerance and result s for elderly patients is quite limited. This study was conducted to invest igate the feasibility and results of curative nonsurgical treatment of pati ents age 75 years or older with anal carcinoma. METHODS. From January 1976 through lune 1996, invasive anal squamous cell c arcinoma was diagnosed in 58 patients age greater than or equal to 75 years . Curative treatment was administered to 47 patients (81%), of whom 42 rece ived radiotherapy [RT), either used alone (21) or associated with concomita nt chemotherapy (CT]. RT was administered in true sequences, the first in w hich a median dose of 39.6 gray (Gy) was delivered dth megavoltage photon b eams, followed (after a median interval of 43 days) by a boost with either brachytherapy or external beam (median dose, 20 Gy). Cf started on Day 1 an d generally consisted of I cycle of mitomycin C (MMC; median dose, 9.5 mg/m (2)) and a 96-hour infusion of 5-fluorouracil (5-FU; median dose, 600 mg/m( 2)/day). The median follow-up for all patients was 48 months (range, 5-163 months). RESULTS. Of 40 patients (95%) who completed curative treatment, acute toxic ity resulted in shortening of the planned first irradiation sequence in 2 p atients (1 in each group) and an unplanned treatment break in 11 patients ( 4 in the RT group and 7 in the RT-CT group). Grade 2 and 3 acute reactions (RTOG) were observed in 43% and 54% of patients, respectively. Among all Gr ade 3 reactions, 32% occurred in the RT group and 68% in the RT-CT group. I n patients receiving RT-CT, Grade 2-3 leukopenia was observed in 25% of pat ients, Grade 2-3 fatigue was observed in 58% of patients, and Grade 2 cardi ac toxicity related to 5-FU occurred in 1 patient. At 5 years, the overall survival was 54% (39% and 59% for the RT and RT-CT groups, respectively, P = 0.28), and the actuarial local control rate was 78.5% (73% and 83% for th e RT and RT-CT groups, respectively, P = 0.36). Five patients presented wit h Grade 3-4 late complications, all of them in the RT-CT group. CONCLUSIONS. The current series confirms the feasibility of sphincter-conse rving treatment for elderly patients who present with anal carcinoma. Rates of acute or late complications appeared similar to those observed in young er patients, and the oncologic results were at least as favorable as those commonly reported. Cancer 1999;85:26-31. (C) 1999 American Cancer Society.