Gastrointestinal Cancer

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SU_5_2051 - Definitive Radiation Therapy With Chemotherapy for Stage IV Anal Cancer: A National Cancer Database Analysis

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Definitive Radiation Therapy With Chemotherapy for Stage IV Anal Cancer: A National Cancer Database Analysis
T. J. Wilhite1, A. L. H. Arnett1, C. N. Day2, W. S. Harmsen3, K. Roberts1, M. G. Haddock1, C. L. Hallemeier1, and K. W. Merrell4; 1Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 2Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, 3Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, 4Mayo Clinic, Rochester, MN

Purpose/Objective(s): Anal cancer is rare, representing 2-5% of all gastrointestinal malignancies. The prognosis of metastatic anal cancer is generally poor, but for patients with limited metastatic disease, curative-intent radiotherapy and chemotherapy are occasionally considered. We sought to evaluate survival outcomes for patients with Stage IV anal cancer treated with curative intent.

Materials/Methods: The National Cancer Database was used to identify patients with squamous cell carcinoma (SCC) and adenocarcinoma of the anus diagnosed 2004-2013 with American Joint Committee on Cancer (AJCC) Stage IV disease. Patients were stratified based on nodal versus non-nodal metastases. Those who were treated with palliative intent or received less than 45 Gy to the pelvis were excluded from analysis. Univariate analyses were performed to assess correlation of overall survival (OS) with sites of metastatic disease, dose, and patient characteristics.

Results: 516 patients with Stage IV anal cancer treated with curative intent were identified. 86.6% had SCC while 13.4 % had adenocarcinoma. The median dose of radiotherapy was 54 Gy (range: 45-73.8 Gy); 92.6% of patients received concurrent chemotherapy. 30.2% of patients had metastatic disease limited to distant lymph nodes, while 43% had non-nodal distant metastases. 2- and 5–year OS for the entire cohort were 56.7% (95% CI: 52.4-61.3%) and 30.6% (95% CI: 26.2-35.7%), respectively. Patients with adenocarcinoma had reduced OS compared to those with SCC (hazard ratio [HR] = 1.94; 95% CI 1.45-2.59; p < 0.001). Other variables associated with worse OS included male sex, radiotherapy without chemotherapy, T4 disease, and uninsured status. Sites of metastatic disease (nodal versus non-nodal) did not impact OS.

Conclusion: Patients with Stage IV anal cancer treated with curative-intent radiotherapy and chemotherapy can achieve adequate long-term survival. While limited by retrospective and population-based methodology, our study suggests that aggressive management should be considered for patients with limited metastatic disease.

Author Disclosure: T.J. Wilhite: None. A.L. Arnett: None. C.N. Day: None. K. Roberts: None. M.G. Haddock: Board Member; ISIORT. C.L. Hallemeier: Research Grant; Mayo Clinic.

Tyler Wilhite, MD

Mayo Clinic

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