Anal Flashcards
What is the clinical relevance of RTOG 8704?
This trial showed that outcomes for anal cancer are inferior with RT + 5FU when compared to RT + 5FU + MMC (i.e. the MMC is necessary for anal cancer).
What was the patient population studied in RTOG 8704?
291 pts; any stage anal SCCa
What was the regimen studied in RTOG 8704?
RT (45Gy) + 5FU +/- MMC
What were the results of RTOG 8704?
Improved with MMC:<div>4 yr colostomy free survival (91% vs 78%)<div>DFS (73% vs 51%)</div><div><br></br></div><div>No differencein OS (76% vs 67%)</div></div><div><br></br></div><div>Worse toxicity with MMC (heme)</div>
“<span><span>What is the clinical relevance of EORTC 22861?</span></span>”
Showed that adding 5FU and MMC to RT improves outcomes for anal cancer
“What was the population studied in<span><span>EORTC 22861?</span></span>”
103 pts; T3 or T4 or N+
“What were the results of<span><span>EORTC 22861?</span></span>”
Improved with addition of 5FU/MMC:<div>CR rate (80% vs 54%)</div><div>5 yr LC (68% vs 50%)</div><div>Colostomy free survival (72% vs 40%)</div><div><br></br></div><div>No difference in OS (65% vs 72%)</div>
“What was the regimen studied in<span><span>EORTC 22861?</span></span>”
RT (45Gy + 15-20Gy boost) +/- 5FU and MMC
What is the clinical relevance of ACT I?
Showed that adding 5FU and MMC to RT improves outcomes for patients with anal SCCa
What population was studied in ACT I?
577 pts; Stage II-IV anal SCCa
What regimen was studied in ACT I?
RT (45Gy + 15Gy boost) +/- 5FU and MMC
What were the results of ACT I?
Improved with addition of 5FU/MMC:<div>3 yr LC (66% vs 41%)</div><div>Cancer specific survival</div><div>Colostomy free survival</div><div><br></br></div><div>No difference in OS</div>
Did ACT I show that adding chemotherapy to RT in anal cancer caused increased non-cancer related deaths?
At 5 years, yes (9.1% increase). However, this difference disappeared at 10 years.
What is the clinical relevance of ACT II?
Showed that RT + concurrent 5FU/MMC was equivalent to RT + concurrent 5FU/Cisplatin. Since Cisplatin is harder to administer, MMC remains standard of care.
What population was studied in ACT II?
940 pts; anal SCCa; all stages
What regimen was studied in ACT II?
RT (50.4 Gy) + concurrent 5FU with either MMC (1 cycle) or Cisplatin (60mg/m2)<div><br></br></div><div>*Also studied adjuvant 5FU/Cis vs no CHT but there was no benefit to this</div>
What were the results of ACT II?
No difference in outcomes among arms<div>3 yr CR: ~90%</div><div>3 yr CFS: ~75%</div><div>3 yr PFS: ~75%</div><div><br></br></div><div>Also no benefit to adding adjuvant CHT</div>
What is the clinical relevance of RTOG 9811?
Showed that RT + concurrent 5FU/MMC is superior to induction 5FU/Cisplatin followed by RT + concurrent 5FU/Cisplatin.<div><br></br></div><div>(essentially showed that induction is not helpful and 5FU/MMC is at least as good as 5FU/Cisplatin if not better)</div>
What population was studied in RTOG 9811?
644 pts; T2-T4 tumors with any N; anal SCCa
What was the regimen studied in RTOG 9811?
Arm 1: RT (45-59Gy) + concurrent 5FU/MMC<div><br></br><div>Arm 2: Neoadjuvant 5FU/Cisplatin –> RT (45-59Gy) + concurrent 5FU/Cisplatin</div></div>
What were the results of RTOG 9811?
Significantly better OS, DFS, and CFS with 5FU/MMC arm:<div>5 yr OS 78% vs 71%</div><div>5 yr DFS 68% vs 58%</div><div>5 yr CFS 72% vs 65% (p=0.05)</div><div><br></br></div><div>Also showed induction not helpful</div>
What two trials compared RT + 5FU/MMC with RT + 5FU/Cisplatin? And what are the key differences?
ACT II and RTOG 9811<div><br></br></div><div>ACT II: also analyzed adjuvant CHT, MMC was only 1 cycle</div><div><br></br></div><div>RTOG 9811: also analzed neoadjuvant CHT, MMC was 2 cycles</div>
What is the key message of RTOG 9811 and ACT II?
5FU/MMC is preferred over 5FU/Cisplatin for concurrent treatment with RT for anal SCCa
What is the clinical relevance of RTOG 0529?
Showed the benefit of IMRT for anal SCCa
What population was studied in RTOG 0529?
63 pts; T2-4N0-3; anal SCCa
What was the RT dosing paradigm established by RTOG 0529?
“<div><span>Gross Disease:</span></div><span>T2: 50.4Gy</span><div><span>T3/4: 54Gy</span></div><div>Node <3cm: 50.4 Gy</div><div>Node >3cm: 54 Gy</div><div><br></br></div><div>Elective Nodes:</div><div>T2 Primary: 42 Gy</div><div>T3/4 Primary: 45 Gy</div>”
What was the treatment paradigm in RTOG 0529?
RT + concurrent 5FU/MMC utilizing IMRT
What were the key outcomes of RTOG 0529? What trial did they compare their results to?
“Compared to RTOG 9811, this trial showed lower Grade 3+ skin and GI, and lower Grade 2+ heme toxicities.<div><br></br></div><div><span>RTOG 0529 vs. 9811:</span><br></br><span>grade 2+ heme: 73% vs. 85%</span><br></br><span>grade 3+ skin 23% vs. 49%</span><br></br><span>grade 3+ GI: 21% vs. 36%</span><br></br></div><div><br></br></div>”
What are the key dose constraints that came from RTOG 0529?
“<div>Small bowel (V45<20cc)</div><div>Femoral heads (V44<5%)</div><div><br></br></div><img></img>”
