Radiochemotherapy and brachytherapy could be the standard treatment for anal canal cancer in elderly patients? A retrospective single-centre analysis

Goal To retrospectively analyse all our elderly patients (>70 years old) treated with radiotherapy +/- chemotherapy (RT +/- CT) followed by brachytherapy (BRT) for anal canal cancer. Background Studies on clinical outcomes and toxicities of the standard treatments for anal canal cancers in elderly patients are rare and data are not homogeneous, so a standard of care cannot be defined for these patients. Study A retrospective analysis of efficacy and safety of RT +/- CT followed by BRT has been performed. The impact of the modified Charlson Index and of other different clinical and therapeutic variables on these outcomes has been also studied. Results Seventy-six elderly patients with a histological diagnosis of anal canal cancer and with a median age of 76 years (range 70-88) were treated with a curative goal. Patients received radiotherapy alone (37/76, "RT group") or radiochemotherapy (39/76, "RT-CT group"). All patients underwent a BRT boost. Five-year local control, overall survival, disease-specific survival, nodal progression-free survival and metastasis-free survival rates were 75.8, 75.8, 82.8. 87.8 and 89.0 %, respectively. Globally, the incidence of acute and late Grade 3-4 toxicities was 14.5 and 6.6 %, respectively. Only 2 patients received surgery because of severe ano-rectal toxicities. Any relationship between the modified Charlson Index and all the considered clinical outcomes was found. Conclusions Curative RT +/- CT + BRT showed an acceptable toxicity profile and a good efficacy also in elderly anal canal cancer patients and should be considered as an important therapeutic option also for these patients.