The incidence of anal cancer continues to rise. Despite making the headlines with Farrah Fawcett, people are still reluctant to discuss this important cancer. The majority of patients with this cancer are cured by a combination of treatment of radiation and chemotherapy. However, this treatment can have significant side effects, particularly in the elderly or those in poor general health. In a study featured in the July 2018 issue of the Diseases of the Colon and Rectum, researchers from the Icahn School of Medicine at Mount Sinai in New York City used the Surveillance, Epidemiology and End Results (SEER) Registry linked to Medicare and studied 99 patients with stage I anal cancer who were treated only with radiation therapy and compared these to 200 patients who were treated with the standard combination of chemotherapy and radiation. After adjusting for patient comorbidities, HIV status, use of home health services, sociodemographic characteristics and other factors, they found that there was no difference in overall-, cause-specific, colostomy-free or disease-free survival. In contrast, chemoradiation was associated with more early and late side effects due to treatment. The authors concluded that radiation therapy alone may provide for adequate cancer treatment when used to treat older, sicker patients with early stage anal cancers.
A quote from the first author Michael Buckstein: “This study uses SEER-Medicare to generate the largest series, to our knowledge, of Stage I patients to explore outcomes of chemoradiation versus radiation alone.”