A Clinical Audit of Anal Cancer in a Single Tertiary Centre Over 10 Years — ASN Events

A Clinical Audit of Anal Cancer in a Single Tertiary Centre Over 10 Years (#309)

Peey-Sei PS Kok 1 , Susan Pendlebury 1 , Annabel Smith 2 , Sophie Jarvis 3 , Eva Segelov 1 4
  1. St Vincent's Hospital, Darlinghurst, NSW, Australia
  2. School of Medicine, James Cook University, Townsville, QLD, Australia
  3. School of Medicine, University of Adelaide, Adelaide, SA, Australia
  4. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

Patients with early anal cancer have a good prognosis with curative treatment although those with underlying HIV are reported as doing significantly worse.1 To examine the outcomes of patients in the era of HAART (Highly active antiretroviral therapy) which have previously been documented only in small series1,2 , this clinical audit was undertaken. This study reports the demographic of anal cancer patients in a single tertiary centre in Sydney with a high population of HIV patients. A retrospective review was performed on all patients who were diagnosed with anal cancer between 2004 and 2013. 83 patients were identified with a median time of follow up of 2 years. Three patients were excluded from further analysis because they only had one visit for a second opinion (n=2) or pathology review reclassified to non-invasive disease (n=1). Seventy seven patients presented with non-metastatic disease at diagnosis, six later developed metastatic and/ or recurrent diseases. Three patients had metastatic (n=2) or recurrent disease at presentation (n=1). Median age was 55.5 years (range: 38-80) with 74% male. 83% of patients were HIV positive (97% males). Seventy-four patients received initial concurrent chemoradiation with curative intent (57 patients had Mitomycin-C and 5-Fluorouracil, 14 had Cisplatin and 5- Fluorouracil, 3 had Mitomycin-C and Capecitabine). Two patients had upfront surgeries (1 because of prior prostate RT and the other refused chemotherapy) and one had radiotherapy only (CD4 count too low for chemotherapy) as initial treatment for non-metastatic disease. Chemotherapy was given at full dose initially despite CD4 count. Patients who developed metastatic disease had at least 2 subsequent lines of palliative chemotherapy. There were 8 deaths, seven due to progressive disease and one due to likely treatment toxicity (sudden death after chest pain on 5-Fluorouracil). Five patients who died were HIV positive. Further details of demographics and outcomes will be described. 

  1. Edelman S, Johnstone PA.Combined modality therapy for HIV-infected patients with squamous cell carcinoma of the anus: outcomes and toxicities. Int J Radiat Oncol Biol Phys. 2006 Sep 1;66(1):206-11.
  2. Stadler RF, Gregorcyk SG, Euhus DM, Place RJ, Huber PJ, Simmang CL. Outcome of HIV-infected patients with invasive squamous-cell carcinoma of the anal canal in the era of highly active antiretroviral therapy. Dis Colon Rectum. 2004 Aug;47(8):1305-9.