Chemoradiation is the standard primary treatment for cancer of the anal canal. Current standard treatment combines radiotherapy with 5FU (fluorouracil) and mitomycin.
Studying the possibility of a better treatment, gastrointestinal researchers compared the standard treatment with mitomycin and radiotherapy to a new regimen that combined 5FU with cisplatin and radiotherapy in a randomized clinical trial. The goal was to find out which treatment was most effective in preventing the cancer from returning within 5 years (disease-free survival).
- Overall, the standard treatment outperformed the new experimental therapy.
- Five year disease-free survival was 60 percent for mitomycin-based treatment compared to 54 percent for cisplatin-based therapy.
- Overall survival at five years was 75 percent for mitomycin, 70 percent for cisplatin.
- 25 percent of the mitomycin group had their cancer come back in the anal canal (local recurrence) compared to 33 percent of the cisplatin group.
- 15 percent of mitomycin patients had cancer spread to distant organs (metastasis) compared to 19 percent of the cisplatin patients.
- 10 percent of mitomycin patients needed a colostomy compared to 19 percent of those receiving cisplatin-based treatment.
However, mitomycin caused more severe drops in blood counts.
Courtesy of JAMA
Led by Jaffer A. Ajani, MD, the research team concluded,
In this population of patients with anal canal carcinoma, cisplatin-based therapy failed to improve disease-free-survival compared with mitomycin-based therapy, but cisplatin-based therapy resulted in a significantly worse colostomy rate. These findings do not support the use of cisplatin in place of mitomycin in combination with fluorouracil and radiotherapy in the treatment of anal canal carcinoma.
The Journal of the American Medical Association includes information for patients describing anal cancer risks, diagnosis, and treatment in the same issue.
SOURCE: Ajani et al. Journal of the American Medical Association, Volume 299, Number 15, April 23, 2008.
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