Chemo-radiation with or without mandatory split in anal carcinoma: experiences of two institutions and review of the literature

Table 3 Review of the literature: retrospective trials.

study	n	Stage	total	RT dose (Gy) pelvic	inguinal	Split	CT	OS (%)	LC (%)	CFS (%)	toxicity overall	skin	diarrhea	BM	adherence (%)
Vuong (2007)	62	T2-4N0-3	54	27-30	27-30	cont	MMC¹, 5-FU	81	85		37	19	5	13	100
McGill	60	T2-4N0-3	45-58.9			split	MMC¹, 5-FU	54	61		70	43	11	17
Meyer (2006)	35	T1-4N0-3	55,8	45	e (45)	cont (≤ 1 w)	MMC, 5-FU	71	85	85		29	3		50
Hannover	32	T1-4N0-3	55,8	45	e (45)	split (>1 w)	MMC, 5-FU	63	81	87		27	12
Graf (2003)	38	T1-4N0-3	45	30 (45)²	30-45	cont	MMC, 5-FU		79						52
Berlin	65	T1-4N0-3	45	30 (45)²	30-46	split (1 w)	MMC, 5-FU		58
Tanum (1991,1993)	117	T1-4N0-3	50 (-54*)	50		cont	MMC, 5-FU	72	75-93			34	9	1
Oslo
Ferrigno (2005)	43	T1-4N0-3	55	45	e (55)	cont	MMC, 5-FU	68 (5 y)	79 (5 y)	52 (5 y)		74	44	21	72³
Sao Paolo
Widder (2008)	108	T1-4N0-3	60	30	30⁵	split (2-3 w)	MMC, 5-FU	57	86	51
Vienna	21					or cont⁴
Doci (1992)	56	T1-3N0-3	54-60	36	36	split (2 w)	MMC, 5-FU	81 (8 y)	53-74*			5	4	7
Milan
Ceresoli (1998)	35	T2-4N0-3	56	45	e (56)	split (2 w)	MMC, 5-FU	71 (5 y)		70 (3 y)		75*		14**
Milan
Weber (2001)	45	T1-4N0-3	60¹¹	40	40	split (<38 d)	MMC, 5-FU		85¹⁰
Geneva	45	T1-4N0-3	60¹¹	40	40	split (>37 d)	MMC, 5-FU		62¹⁰
Constantinou (1997)	50	T1-4N0-3	54	30-36	30-36 (45)⁶	split	MMC, 5-FU	66 (5 y)	70 (5 y)
MGH
Mai (2008)	90	T1-4N0-3	50-54	30.6 (45-50.4)⁹	30-36	cont or split⁸	MMC, 5-FU	86 (5 y)⁷	79 (5 y)			49	1	24
Mannheim
Grabenbauer (2005)	87	T1-4N0-3	55.8-66.4	50,4	50,4	cont or split	MMC, 5-FU	75 (5 y)	ca. 90	87 (5 y)		45	34	35
Erlangen

EBRT = external beam radiotherapy, RT = radiotherapy, CT = chemotherapy, T = tumor stage, N = nodal stage, w = week, mo = months, y = years, OS = overall survival, LC = local control, CFS = colostomy-free survival, cont = continuous, e = elective, 1 = MMC or cisplatin, 2 = T3/4 tumors were treated with 30 Gy to L4/5, T1-4 45 Gy to lower iliosacral joints, 3 = 28% split with 15 d median, 4 = 16% continuous, 5 = 45 Gy if no staging with CT scan, 6 = 45 Gy to medial nodes, 7 = disease-free survival, 8 = 75 pts continuous, 9 pts according to Cummings regimen (48-50 Gy, 4 w split), 6 pts according to RTOG (59.4 Gy, 2 w split), 9 = field reduction from L4/5 to lower iliosacral joint after 30.6 Gy, 10 = locoregional, 11 = brachytherapy boost in some patients. References: Vuong [10], Meyer [11], Graf [16], Tanum [26], Widder [18], Doci [23], Ceresoli [31], Weber [15], Ferrigno [19], Mai [24], Grabenbauer [32], Constantinou [17]

ISSN: 1748-717X