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Surveillance of anal carcinoma after radiochemotherapy

A retrospective analysis of 80 patients

Nachsorge beim Analkarzinom nach Radiochemotherapie

Eine retrospektive Analyse von 80 Patienten

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Abstract

Background

Surveillance after radiochemotherapy of anal carcinoma (ACa) with curative intent is recommended in guidelines, but data regarding the effectiveness of follow-up are lacking. We aimed to assess the performance of an ACa surveillance program in a real-life setting.

Methods

We retrospectively summarized clinical history, physical findings, and follow-up investigations (endoanal ultrasound, endoscopy, CT scan) obtained during 42 months (±27 months) from 80 patients after radiochemotherapy of ACa.

Results

In 7/80 cases (8.8%) an incomplete response to therapy was identified at or before the 6‑month time point after the end of treatment; 4 of the 7 cases were identified during scheduled follow-up. In 6 cases (7.5%), recurrent disease was found after the 6‑month time point. Recurrence was systemic in 5 cases and local/inguinal in 1 case. In 3 of the 6 cases (50%), recurrence was identified during scheduled follow-up. In one asymptomatic patient, a single liver metastasis was detected during scheduled follow-up and the patient remains free of disease 19 months after surgery. Surveillance resulted in a high rate of false-positive findings (70 findings in 604 investigations), of which only 14 could be confirmed.

Conclusion

Scheduled follow-up after treatment of ACa detected recurrent disease at systemic sites, enabling potentially curative treatment in a single case. Effectiveness of abdominal imaging during follow-up after ACa treatment should be tested in a prospective trial.

Zusammenfassung

Hintergrund

Nach kurativ intendierter kombinierter Radiochemotherapie beim Analkarzinom (ACa) wird von den Guidelines eine Nachsorge empfohlen, die Datenlage hierzu ist jedoch mangelhaft. Ziel unserer Studie war es, die Wertigkeit der Nachsorge beim ACa in einem „Real-life“-Setting zu evaluieren.

Methoden

Es erfolgte die retrospektive Aufarbeitung der Nachsorge inklusive Anamnese, klinischer Untersuchung und Nachsorgeuntersuchungen (untere Endosonographie, Endoskopie, Computertomographie Abdomen/Becken) während 42 (±27) Monaten bei 80 Patienten nach kurativer Radiochemotherapie eines ACa.

Ergebnisse

Bei 7/80 Patienten (8,8 %) wurde bei oder vor der 6‑Monats-Kontrolle nach Ende der Radiochemotherapie ein inkomplettes Ansprechen dokumentiert; 4 der 7 Fälle wurden aufgrund geplanter Nachsorgeuntersuchungen entdeckt. In 6 Fällen (7,5 %) wurde nach der 6‑Monats-Kontrolle ein Rezidiv festgestellt. Die Rezidive waren Fernmetastasen in 5 Fällen und ein lokoregionäres Rezidiv in einem Fall. In 3/6 Fällen (50%) wurden die Rezidive während der geplanten Nachsorgeuntersuchung entdeckt. Bei einem asymptomatischen Patienten wurde in der Nachsorge eine singuläre Lebermetastase diagnostiziert; nach Resektion blieb der Patient während der restlichen Nachsorge von 19 Monaten rezidivfrei. Die Nachsorge führte zu einer hohen Rate an falsch-positiven Befunden (70 Befunde in 604 Untersuchungen), welche nur in 14 Fällen als wirklich relevant bestätigt werden konnten.

Schlussfolgerung

Mit der geplanten Nachsorge nach kurativer Radiochemotherapie beim ACa konnten systemische Rezidive entdeckt werden, die zumindest in einem Fall potenziell kurativ behandelt werden konnten. Die Effizienz einer abdominellen Bildgebung bei der Nachsorge des ACa sollte in einer prospektiven Studie untersucht werden.

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Abbreviations

ACa:

Anal carcinoma

CI:

Confidence interval

CT:

Computed tomography

DRE:

Digital rectal examination

HIV:

Human immunodeficiency virus

HPV:

Human papillomavirus

MRI:

Magnetic resonance imaging

OR:

Odds ratio

5-FU:

5-Fluorouracil

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Funding

This study was supported by a grant from the Swiss Cancer League and the Horten Foundation to BM.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland

    Matthias Sauter MD &  Stephan R. Vavricka MD

  2. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland

    Matthias Sauter MD,  Stephan R. Vavricka MD, Henriette Heinrich &  Benjamin Misselwitz MD

  3. Division of Radiation-Oncology, Triemli Hospital, Zurich, Switzerland

    Georg Keilholz, Helmut Kranzbühler MD & Norbert Lombriser MD

  4. Department of Oncology, University Hospital Zurich, Zurich, Switzerland

    Thomas Winder MD PhD

Authors
  1. Matthias Sauter MD
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  2. Stephan R. Vavricka MD
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  3. Georg Keilholz
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  4. Henriette Heinrich
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  5. Thomas Winder MD PhD
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  6. Helmut Kranzbühler MD
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  7. Norbert Lombriser MD
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  8. Benjamin Misselwitz MD
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Corresponding author

Correspondence to Matthias Sauter MD.

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Conflict of interest

M. Sauter, S.R. Vavricka, G Keilholz, H. Heinrich, T. Winder, H. Kranzbühler, N. Lombriser, and B. Misselwitz declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. The Retrospective, anonymized data analysis was approved by the local ethics committee of Zurich County (KEK-ZH 2010-0555).

Additional information

Availability of data and materials

All data generated or analyzed during this study are included in this published article (and its supplementary information files).

Contribution

BM, SV, HK, NL: study design; MS, SV, GK and BM: data acquisition, data analysis, drafting of manuscript; all authors: critical review and final approval of manuscript.

Caption Electronic Supplementary Material

66_2017_1159_MOESM1_ESM.docx

Table S1A Summary of investigations within the first year after the end of treatment (A). Table S1B Summary of investigations after the first year after treatment (B). Table S2 Findings at physical examinations within the first year after end of treatment. None of the differences yielded statistical significance (Fisher’s exact test). Table S3 Symptoms during the first year after end of treatment. None of the differences yielded statistical significance (Fisher’s exact test). Table S4 Findings of endoanal ultrasound (EUS) within the first year after end of treatment. EUS findings and patient outcomes are summarized. None of the differences yield statistical significance (Fisher’s exact test)

66_2017_1159_MOESM2_ESM.docx

Table S5 Symptoms, physical findings, and results of investigations of patients with incomplete response after radiochemotherapy

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Sauter, M., Vavricka, S.R., Keilholz, G. et al. Surveillance of anal carcinoma after radiochemotherapy. Strahlenther Onkol 193, 639–647 (2017). https://doi.org/10.1007/s00066-017-1159-0

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