Effective treatment of anal cancer: A Synthesis of Findings from 19 Studies

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Original Abstract of the Article

Major research findings

Anal cancer is a rare gastrointestinal tumor, but its incidence is increasing. 9 More than 90% of anal cancers are squamous cell cancers (SCC) and are nearly always associated with human papillomavirus infection. 9 The standard treatment for localized anal cancer is a combination of radiation therapy and chemotherapy, known as chemoradiotherapy. 6 14 Chemoraditherapy has significantly improved cancer outcomes and spared patients from the morbidity of colostomy surgery. 6 However, chemoradiotherapy has its own acute and chronic toxicity profile, which has been significantly reduced over the years with the development of advanced radiotherapy techniques. 6 Intensity modulated radiotherapy (IMRT) is considered to be the primary definitive treatment for anal cancer, with similar survival rates and the potential to reduce acute toxicity compared to 3D-conformal radiotherapy (3D-RT). 12 The use of magnetic resonance imaging (MRI) has become increasingly important in anal cancer treatment, playing a crucial role in diagnosis, treatment response assessment, detection of recurrent disease, and evaluation of potential complications. 8 10 The hybrid MRI scanner and radiation therapy linear accelerator (MR-Linac) has the potential to enhance clinical outcomes for anal cancer patients, with improved soft tissue visualization and daily plan adaptation. 7 However, it presents some limitations due to the incorporation of MRI, including longer treatment times and high cost. 7 The emergence of immunotherapy has opened new therapeutic perspectives for the treatment of anal cancer, with new standards of care being established and clinical trials being developed. 13 The InterAACT trial demonstrated that carboplatin plus paclitaxel is the standard of care for advanced disease. 18 For chemorefractory patients, nivolumab and pembrolizumab have shown promising results, regardless of PD-L1 expression. 18

Treatment summary

Treatment for anal cancer is tailored based on the stage of the tumor and the patient's individual condition. 9 For localized disease, chemoradiotherapy is the standard of care, combining radiation therapy and chemotherapy with mitomycin C and 5-fluorouracil. 14 IMRT is increasingly preferred as it can reduce acute toxicity compared to 3D-RT. 12 Surgery may be considered for cases where chemoradiotherapy is ineffective or in cases of recurrence. 6 For advanced disease, systemic chemotherapy is often used, with carboplatin plus paclitaxel being the current standard of care. 18 Immunotherapy is showing promise as a new treatment modality for anal cancer. 13 18

Benefits and risks

Benefit summary

Chemoraditherapy has significantly improved cancer outcomes and spared patients from the morbidity of colostomy surgery. 6 IMRT is considered to be the primary definitive treatment for anal cancer, with similar survival rates and the potential to reduce acute toxicity compared to 3D-RT. 12 Immunotherapy is showing promise as a new treatment modality for anal cancer, with new standards of care being established and clinical trials being developed. 13 The InterAACT trial demonstrated that carboplatin plus paclitaxel is the standard of care for advanced disease. 18 For chemorefractory patients, nivolumab and pembrolizumab have shown promising results, regardless of PD-L1 expression. 18

Risk summary

Chemoraditherapy can have side effects such as nausea, diarrhea, and skin irritation. 6 Long-term side effects include cystitis, proctitis, and sexual dysfunction. 6 Surgery carries risks such as infection and bleeding. 6 Immunotherapy can lead to side effects such as fatigue, fever, and skin rash. 13 18

Comparison between studies

Similarities between studies

Several studies have shown that chemoradiotherapy is the standard treatment for anal cancer. 6 11 12 14 The use of MRI has become increasingly important in anal cancer treatment, playing a crucial role in diagnosis, treatment response assessment, detection of recurrent disease, and evaluation of potential complications. 8 10 Treatment for anal cancer is tailored based on the stage of the tumor and the patient's individual condition. 9

Differences between studies

A planning-based feasibility study demonstrated that MR-Linac is feasible for a subset of patients with anal cancer, providing improved soft tissue visualization and daily plan adaptation. 7 However, the current limitations of the MR-Linac system may not be suitable for patients with large target volumes. 7 The study also revealed that MR-Linac plans have lower monitor units but take longer to deliver compared to VMAT plans. 7 Another study compared the effectiveness of IMRT and 3D-RT for the treatment of anal cancer and found that IMRT had similar survival rates but with the potential to reduce acute toxicity. 12

Consistency and inconsistency of results

There is a consistency across multiple studies that chemoradiotherapy is the standard treatment for anal cancer. 6 11 12 14 However, the effectiveness of new treatment modalities such as MR-Linac and immunotherapy requires further research. 7 13 18

Points to consider for real-life application

Treatment for anal cancer is tailored based on the stage of the tumor and the patient's individual condition. 9 It is essential to consult with a doctor to discuss the treatment options and choose the most appropriate one.

Limitations of current research

Further research is needed to investigate the effectiveness of new treatment modalities such as MR-Linac and immunotherapy. 7 13 18 Additionally, more research is needed to standardize anal cancer treatment guidelines and improve patient quality of life. 15 16 17

Future research directions

Future research should focus on investigating the effectiveness of new treatment modalities such as MR-Linac and immunotherapy. 7 13 18 Additionally, more research is needed to standardize anal cancer treatment guidelines and improve patient quality of life. 15 16 17

Conclusion

Treatment for anal cancer has significantly advanced in recent years, with chemoradiotherapy being the standard of care. 6 11 12 14 However, new treatment modalities such as MR-Linac and immunotherapy are being developed and further research is needed to explore their potential. 7 13 18 Treatment for anal cancer is tailored based on the stage of the tumor and the patient's individual condition. 9 It is essential to consult with a doctor to discuss the treatment options and choose the most appropriate one.

List of treatments

Chemoraditherapy, surgery, immunotherapy, IMRT, 3D-RT, MR-Linac

Literature analysis of 19 papers
Positive Content
17
Neutral Content
2
Negative Content
0
Article Type
3
0
2
7
19
1.

Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups.

Author: BartelinkH, RoelofsenF, EschwegeF, RougierP, BossetJ F, GonzalezD G, PeiffertD, van GlabbekeM, PierartM

Improved locoregional control
Reduced colostomy need
Anal ulcers

Adding chemotherapy to radiotherapy in patients with locally advanced anal cancer significantly increased the complete remission rate from 54% to 80%, improved locoregional control by 18% at 5 years, and reduced the need for colostomy by 32% at 5 years. The 5-year survival rate was 56% for the whole patient group.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I).

Author: NorthoverJ, Glynne-JonesR, Sebag-MontefioreD, JamesR, MeadowsH, WanS, JitlalM, LedermannJ

Reduced anal cancer deaths
Reduced locoregional relapse
Non-anal cancer deaths

Chemoradiation had a clear benefit over radiotherapy alone for treating epidermoid anal cancer. The benefit was still seen 12 years after treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

Comparison of imiquimod, topical fluorouracil, and electrocautery for the treatment of anal intraepithelial neoplasia in HIV-positive men who have sex with men: an open-label, randomised controlled trial.

Author: RichelOlivier, de VriesHenry J C, van NoeselCarel J M, DijkgraafMarcel G W, PrinsJan M

Anal cancer prevention
Side effects

Anal cancer is becoming more common in HIV-positive men who have sex with men. The best treatment for anal intraepithelial neoplasia (AIN), the precursor to anal cancer, is still unclear. This study compared the effectiveness and side effects of three different treatments for AIN.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

Systematic review of the quality of life issues associated with anal cancer and its treatment with radiochemotherapy.

Author: SodergrenSamantha C, VassiliouVassilios, DennisKristopher, TomaszewskiKrzysztof A, GilbertAlexandra, Glynne-JonesRobert, NugentKaren, Sebag-MontefioreDavid, JohnsonColin D,

Anal carcinoma treatment

Radiochemotherapy is the standard treatment for anal cancer, helping control the cancer and preserve the anal sphincter. However, this treatment can cause side effects. This review examines how anal cancer and radiochemotherapy affect quality of life (QoL) and how QoL is measured in anal cancer patients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

5.

Quality of life in patients treated for anal carcinoma-a systematic literature review.

Author: SternerAnton, DerwingerKristoffer, StaffCaroline, NilssonHanna, AngeneteEva

Anal cancer treatment

Anal cancer is typically treated with a combination of chemotherapy and radiation therapy. Surgery is used less often. There is a lack of research on how these treatments affect quality of life and overall function in people with anal cancer. This review aims to identify areas for further research in this area.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

6.

Acute and Chronic Complications After Treatment of Locoregional Anal Cancer: Prevention and Management Strategies.

Author: KatzLeah, HorowitzDavid P, KachnicLisa A

Anal cancer treatment
CRT for anal cancer
CRT toxicity

This study provides practical guidance for managing acute and chronic complications arising from definitive chemoradiotherapy (CRT) for anal cancer. It aims to support the multidisciplinary care team in mitigating and managing these toxicities, which have improved with advancements in radiotherapy techniques.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

9.

[Diagnostics, treatment and aftercare of anal cancer].

Author: AignerFelix, SiegelRobert

Anal cancer treatment

This article provides an overview of squamous cell carcinoma (SCC) of the anal canal and anal margin, focusing on diagnostics, surgical treatment, response assessment, and aftercare. The article emphasizes the importance of an interdisciplinary approach to treatment and outlines the standard treatment strategies for different stages of anal cancer.

English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : German

10.

Follow-up imaging of anal cancer after treatment.

Author: El HomsiMaria, SheedyShannon P, RauchGaiane M, GaneshanDhakshina M, ErnstRandy D, Golia PernickaJennifer S

MRI for anal cancer treatment

This review focuses on the role of imaging, particularly magnetic resonance imaging (MRI), in assessing treatment response in anal cancer. MRI is considered essential for evaluating treatment response, detecting recurrent disease, and identifying post-treatment complications.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

11.

Treatment, outcome, and prognostic factors in non-metastatic anal cancer: The French nationwide cohort study FFCD-ANABASE.

Author: VendrelyVéronique, LemanskiClaire, PommierPascal, LE MalicotKarine, SaintAngélique, Rivin Del CampoEleonor, RegnaultPauline, Baba-HamedNabil, RonchinPhilippe, CrehangeGilles, TougeronDavid, Menager-TabourelElodie, DiazOlivia, HummelsbergerMichael, MinsatMathieu, DrouetFranck, LarrouyAnne, PeiffertDidier, LievreAstrid, ZasadnyXavier, HautefeuilleVincent, MornexFrançoise, LepageCôme, QueroLaurent,

Cancer treatment

This study evaluated clinical practices, treatment, and outcomes of squamous cell carcinoma of the anus (SCCA) patients in France. The study's findings are crucial for assessing the effectiveness of current treatments and improving patient care.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Observational StudyResearch that observes and collects data on participants' behavior and outcomes in their natural state, without intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

13.

The emerging role of immunotherapy in the treatment of anal cancer.

Author: Saúde-CondeRita, ParisiAlessandro, GiuntaEmilio Francesco, MeyersMichel, SclafaniFrancesco

Immunotherapy
New Standards of Care

This review examines the use of immunotherapy in treating anal cancer, including its rationale, available clinical data, and ongoing research efforts.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

15.

Guidance documents for colorectal and anal cancer treatment: A systematic quality and reporting assessment.

Author: Maes-CarballoMarta, García-GarcíaManuel, Gómez-FandiñoYolanda, De-Dios-de-SantiagoDiego, Martínez-MartínezCarmen, Bueno-CavanillasAurora, KhanKhalid Saeed

This study analyzes the quality and reporting of colorectal and anal cancer clinical practice guidelines (CPGs) and consensus statements (CSs). The researchers found that many CPGs and CSs lacked a consistent methodology, highlighting the need for improved quality in healthcare guidelines.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

17.

ECOG-ACRIN Guideline for Contouring and Treatment of Early Stage Anal Cancer Using IMRT/IGRT.

Author: DamicoNicholas, MeyerJoshua, DasPrajnan, MurphyJames, MillerEric, KoontzBridget, HallWilliam, McBrideMary, PereiraGisele, CatalanoPaul, ChakravarthyA Bapsi, O'DwyerPeter J, DorthJennifer

Anal cancer treatment

This guideline provides customized radiation treatment recommendations for early-stage (T1-2 N0 M0) anal cancer treated with intensity modulated and image guided radiation therapy (RT). It aims to tailor treatment volumes based on disease stage and other factors, potentially improving treatment efficacy and minimizing side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Practice GuidelineGuidelines and recommendations for the diagnosis and treatment of specific medical conditions in medical practice.

Language : English

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