Background: First clinical data on a new intracavitary afterloading boost method for anal canal carcinoma is reported.
Patients and methods: 20 consecutive patients (T1 5%, T2 70%, T3 20%, T4 5%; N0 75%, N1 10%, N2 15%; all M0) treated with external beam pelvic radiotherapy (median dose 56 Gy, range 46-64 Gy), simultaneous 5-FU and mitomycin (in 75%) and an intracavitary afterloading boost (one or two fractions of 5 Gy at 5 mm depth) were analyzed after a mean +/- SD follow-up for living patients of 4.4 +/- 2.1 years. Quality of Life (QoL) and anorectal manometry parameters were assessed in ten colostomy-free survivors.
Results: Overall, recurrence-free and colostomy-free survival at 5 years were 84%, 79% and 69%, respectively. No death was tumor-related. The only local failure was successfully salvaged by local excision. All three colostomies were performed for toxicity. Resting pressure and maximum squeeze pressure of the anal sphincter were reduced by 51% and 71%, as compared with control subjects, but quality of life was similar compared to healthy volunteers.
Conclusion: The described regimen is highly effective but associated with increased toxicity.