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. With median follow-up of 8.0 years for surviving patients (3.9 years including deceased patients), five-year overall survival and disease-free-survival were 57% and 51%, respectively. Local control at 5 years was 87%. 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. (C) 2008 Elsevier Ireland Ltd. All rights reserved.