Experience with split-course external beam irradiation +/- chemotherapy and integrated IR-192 high-dose-rate brachytherapy in the treatment of primary carcinomas of the anal canal

Purpose: The effect of the treatment of anal cancer by performing a high-do se-rate (HDR) brachytherapy boost during a short split between the external beam radiotherapy series (EBR) +/- chemotherapy was investigated. Methods and Materials: Thirty-nine patients with anal canal cancers, stages T1-T4 N0-2 MO, were treated with split-course EBR (50-50.4 Gy) and a Iridi um 192 (Ir-192-) HDR boost (6 Gy) performed during the 1-2-week split. Pati ents who failed to achieve a complete tumor response received additional br achytherapy. Chemotherapy with 5-fluorouracil and mitomycin C was offered t o patients with tumors > 3 cm and employed concomitantly on days 1-5 and da y 1, respectively, of each EBR series. Results: Follow-up ranged from 3 to 140 months (median 31). Median treatmen t duration was 56 days. The 3-year (5-year) actuarial rates of locoregional control (LRC) and disease-specific survival (DSS) were 81% (76%) and 80% ( 76%), respectively. The crude rate of anal preservation was 77% overall, an d 97% in patients in whom LRC was achieved. Uncompromised anal function was recorded in 93% of these patients. The actuarial 3-year (5-year) rate of c olostomy-free survival (CFS) was 78% (73%). There was a statistically signi ficant difference in LRC and DSS according to stage, tumor size, and nodal status. Complications requiring surgical intervention occurred in 7.6% of p atients. Conclusion: The integration of the HDR boost in a split-course ESR regimen +/- chemotherapy resulted in excellent sphincter function without an increa se of severe complications and with rates of LRC, DSS, and CFS, which compa re favorably with those reported in the literature. (C) 2001 Elsevier Scien ce Inc.