Abstracts / 2nd International Syniposyum oil Organ Sparing Treahneni
6
Initiation of sphincter sparing treatment for squamous cell carcinoma of the anal canal in a North American Community Hospital
Robert C. Miller1, Heidi Mattson2
1 Division of Radiation Oncology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, U.S.A.; 2Department of Medical Records, hmnamiel-St. Joseph's Hospital-Mayo Health System, Mankato, Minnesota, U.S.A.
Objective. In the United States, increasing numbers of patients are choosing to receive oncological therapy in small community cancer centers rather than in academic centers ofexcellence. Providing optimal therapy far uncommon malignancies such as anal cancer in the community setting can be challenging. In a hospital-based cancer center located in a rural community of35,000, a combined modality approach to the treatment ofsquamous cell carcinoma ofthe anal canal was implemented in 1999. After one year, the results and toxicity oftreatment were analyzed.
Materials and Methods. Patients received an initial 30.6 Gy to 36 Gy of external bean radiotherapy (EBRT) to the lower pelvis, inguinal lymph nodes, and anal canal in 1.8 Gy dailyfractions, five days/week. A tatal dose of50.4 to 59.4 Gy EBRT was delivered to the primary tumor using 3-D treatment planning and shrinking fields. Total dose was dependent on tumor response and exclusion of the small bowel from the final boost volume. The regional radiation oncologist, using a dedicated teleradiography system linking the regional center with the primary academic cancer center, reviewed all treatment plans with a sub-specialist radiation oncologist with an interestin GI malignancies.
Chemotherapy was delivered concurrently with EBRT. Cis-platinum ar Mitomycin-C, at the discretion of the treating medical oncologist, was administered on Day 1 and Day 28. 5-Fluorouracil, delivered as either a 96-hour continuous infusion ar daily bolus injections, was administered on Days 1-4 and Days 28-31. A community surgeon and/orgasfroenterologist evaluated the patient eight weeks after completion ofther-apy. A biopsy was performed at the discretion of the endoscopist. The treating oncologists also evaluated patients at eight weeks post-treatment and at three-month intervals thereafter.
Results. At the time of presentation, length of follow up, short term tumor control rates, and acute and delayed toxicity rates will be discussed.
Conclusion. A combined modality approach to the treatment of anal canal malignancies in the community setting is technically feasible with modest, but tolerable, acute toxicity. Difficulties in delivering definitive therapy in an uninterrupted fashion will be addressed at the time of presentation.
Correspondence to: Robert Miller, M.D., Radiation Oncology Mayo Clinic, 200 First St. S.W., 55905 Rochester, Minnesota, USA. Phone: +1 507 345 2960; Fax: +1 507 389 4684; E-mail: Miller.Robert@mayo.edu
Radiol Oiicol 2000; 34(3): 223-49.