Original Research

A retrospective analysis of concurrent chemoradiation for squamous cell carcinoma of the anus in Johannesburg

Phemelo Tshoeu, Vinay Sharma, Paul Ruff
South African Journal of Oncology | Vol 7 | a270 | DOI: https://doi.org/10.4102/sajo.v7i0.270 | © 2023 Phemelo Tshoeu, Vinay Sharma, Paul Ruff | This work is licensed under CC Attribution 4.0
Submitted: 21 March 2023 | Published: 19 September 2023

About the author(s)

Phemelo Tshoeu, Department of Radiation Oncology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Vinay Sharma, Department of Radiation Oncology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Paul Ruff, Department of Medical Oncology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Abstract

Background: Anal cancer is a major cause of mortality and morbidity in low- and middle-income countries (LMICs).

Aim: A retrospective analysis to understand presentation and outcomes of patients with anal cancer, who were treated with a curative intent.

Setting: A radiation oncology unit in quaternary level hospital in South Africa.

Methods: Medical records of patients with invasive squamous cell carcinoma (SCC) of the anal canal who were treated between 2014 and 2019 were reviewed with follow-up until June 2021. The 2D-radiotherapy planning and delivery techniques were used to a dose of 50 Gy, with a boost dose of 6 Gy – 10 Gy for patients with residual disease and concurrent chemotherapy.

Results: Eighty-four patients were included in the analysis. Median age was 45 years (range: 25–73 years), 75% were female patients, 80% of the cohort was human immunodeficiency virus (HIV)-positive, and 17% with a CD4 count below 200 cells/mm3. Eighty-seven percent had locally advanced stage three disease. Concurrent 5-fluorouracil (5-FU) and mitomycin C-based chemotherapy was given in four patients, while 50% had 5-FU plus cisplatin and 16% had radiotherapy alone. Complete clinical response was observed in 54 out of 66 evaluable patients (81.8%) at 6 months post-chemoradiation. Overall survival at 2 years could not be determined because of a significant loss to follow-up rate.

Conclusion: A high HIV-postive rate and an advanced disease stage were observed among cohorts with anal canal SCC treated with a definitive curative intent. Tumour response rates at 6 months were favourable although the 2-year overall survival could not be established.

Contribution: This study contributes to the growing body of research on anal cancer outcomes in LMICs.


Keywords

anal cancer; squamous cell carcinoma; chemotherapy; chemoradiation; HIV; antiretroviral therapy; mitomycin; HPV

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