Emerging data indicate that aggressive treatment of distant metastasis can improve survival in some types of advanced anal cancer, say researchers.
Results from a retrospective review of 30 patients with stage IV anal cancer who had distant metastasis limited to the para-aortic (PA) lymph nodes show that a combination of extended-field radiation therapy and chemotherapy (EF-CRT) substantially improved overall survival (OS) and was well-tolerated.
Three-year OS was 67% and disease-free survival was 42%, reports a group led by Emma B. Holliday, MD, assistant professor in the Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
After a median follow-up of 3.1 years, 18 patients (60%) remained alive and 17 patients were without evidence of anal cancer after definitive and salvage treatments, the study authors said.
“The most important finding of this study is that a significant proportion of patients were free of recurrence or death with extended follow-up,” they write.
“Of eight patients who were followed for at least 4 years, four are currently alive and without evidence of anal cancer at last follow-up, including two patients who have been followed for more than 7 years,” they add.
The report was published in the International Journal of Radiation Oncology, Biology, Physics.
In a statement by the American Society for Radiation Oncology (ASTRO), Holliday said, “The label of ‘stage IV’ cancer is not one size fits all. Although involvement of the para-aortic nodes is considered metastatic disease for squamous cell carcinoma of the anal canal, we have long suspected that these patients do not have the poor prognosis that accompanies a stage IV diagnosis in other cancers. The results from this study showed that aggressive combination treatment with definitive extended-field chemo-radiation can lead to good outcomes.”
The investigators note that about 8000 new cases of anal squamous cell carcinoma are diagnosed each year in the United States. Of these, 20% are considered advanced disease because of metastasis. Typically, patients with stage IV anal cancer and evidence of metastasis are not considered candidates for definitive treatment, they say.
“Based on our findings and institutional experience with treatment of these patients, we would…recommend that all patients presenting with anal cancer and distant metastases isolated to the PA nodes undergo multidisciplinary evaluation to determine patient fitness and feasibility of administering EF-CRT,” they write.
The outcomes they report now support previous results that they reported in 2015 in six patients, the authors point out.
They are also similar to results from studies using EF-CRT for metastatic cervical cancer limited to the PA lymph nodes, which have reported disease-free survival between 29% and 44% over periods of 3 to 8 years.
Accurate Staging
Notably, the study showed that the key to accurate staging was a baseline positron emission tomography/computed tomography (PET/CT) scan, which was associated with improved OS (hazard ratio [HR], 0.20; P = .04). The investigators suggest that PET/CT imaging made it possible to determine whether isolated metastases were truly limited to the PA nodes
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