Chemoradiotherapy of anal cancer is feasible in elderly patients: Treatment results of mitomycin–5-FU combined with radiotherapy at Helsinki University Central Hospital 1992–2003

Figures & data

Table I.  Patients and tumour characteristics.

	Age < 70 years (n = 39)	Age ≥ 70 years (n = 23)
Age
Mean	54 (range 39–69)	77 (range 70–89)
Gender
Females	26	19
Males	13	4
Tumour size
T1	0	2
T2	25	10
T3	12	11
T4	2	0
Nodal status
N0	31	21
N1	0	0
N2	5	2
N3	3	0
Pathology
Epidermoid carcinoma	25	16
-Well or moderately differentiated	19	8
-Poorly differentiated	6	8
Basaloid carcinoma	14	7

Table II.  Comorbidities and permanent medications in elderly patients (n = 23).

Diagnosis	n (%)	Number of comorbidties/patients	n (%)	Number of permanent medications/patients	n (%)
no comorbidities	10 (43%)	none	10 (43%)	none	10 (43%)
hypertensio	3 (13%)	1–2	11 (48%)	1	3 (13%)
hypercholesterolemia	4 (17%)	≥3	2 (9%)	2	3 (13%)
coronary heart disease	6 (26%)			3	2 (9%)
atrial fibrillation	2 (9%)			4	4 (17%)
heart insufficience	6 (26%)			5	1 (4%)
diabetes	2 (9%)
rheumatoid arthritis	1 (4%)

Table III.  Radiotherapy.

Radiotherapy	Age < 70 (n = 39)	Age ≥ 70 (n = 23)
External RT (Gy)	39.6	38.4 (32.4–39.6)
PTV1	5.4	5.4
PTV2	8.8 (5.4.–15.4)	9.5 (5.4–14.6)
PTV3	9.9 (5.4–23.6)	9.0
nodal booster
Brachytherapy (Gy)
cesium 137	n = 7 25.7 (20–30)	n = 8 22.5 (10–30)
iridium 192	n = 15 11 (6–12)	n = 7 9.2 (6–12)
Total treatment time (days)	45 (31–79)	43.3 (31–69)
Continuous radio- therapy	n = 21	n = 12
Split-course radio- therapy	n = 18	n = 11
Duration of gaps (days)	9.7 (7–35)	8.1 (6–21)
Reason of gaps	planned = 8 skin and mucosal eruption = 6 infection = 4	planned = 4 skin and mucosal eruption = 3 infection = 4
Time (days) from end of external RT to brachytherapy	31 (12–53)	43 (8–61)

Table IV.  Alterations in chemotherapy schedule.

	Age < 70 (n = 39)	Age ≥ 70 (n = 23)
Chemotherapy cycles
2 full-dose cycles	35 (90%)	14 (61%)
Only 1 cycle	1 (2.5%)	2 (8%)
Dose reductions
Both agents	1 (2.5%)	3 (13%)
Mitomycin	2 (5%)	2 (8%)
5-FU	–	2 (8%)
Causes of altered schedule
Haematological	2 (5%)	2 (8%)
Haematological + infection	2 (5%)	1 (4%)
Diarrhoea	–	1 (4%)
Cardiological	–	2 (8%)
Intercurrent diseases	–	3 (13%)

Figure 1.  Upper panel: local control and time to local recurrence; lower panel: disease-free survival after chemoradiotherapy in patients over 70 years (thick grey line) and in patients less than 70 years (thin black line).

Table V.  Chemoradiotherapy-related grade 3–4 acute toxicity.

	Age < 70 years (n = 39)	Age ≥ 70 years (n = 23)	p
Haematological	5 (13%)	3 (13%)	NS
Dermatological	15 (38%)	10 (43%)	NS
Diarrhoea	8 (21%)	9 (39%)	0.04
Infection	3 (8%)	1 (4%)	NS
Stomatitis (5-FU)	2 (5%)	5 (22%)	0.09
Cardiological (5-FU)	2 (5%)	3 (13%)	0.14