Should the treatment of anal carcinoma be adapted in the elderly? A retrospective analysis of acute toxicities in a French centre and a review of the literature

Purpose. - To study the tolerance to radiotherapy, with or without chemotherapy, followed by brachytherapy, in elderly patients (75 years or older) suffering from anal cancer. Patients and methods. - We treated 12 elderly patients with a curative intent. Median age was 78 years (range: 75-90). Ten patients had a stage II or IIIA (UICC 2009) tumour and six out of 12 were N+. Taking into account the age, the Eastern Cooperative Oncology Group (ECOG) performance status and comorbidities, five patients received exclusive radiotherapy ("RT group") and seven a concomitant radiochemotherapy ("RT-CT group"). All patients received a boost by interstitial brachytherapy. One patient of the "RT-CT group" presented rectorragies during brachytherapy. The irradiation was completed by external beam radiotherapy focalized on the tumour volume. Results. - Grade 3 acute reactions (Radiation Therapy Oncology Group [RTOG]) were reported in three out of 12 patients. One grade 2-3 leucopoenia was observed in one out of 7 patients ("RT-CT group"). After brachytherapy, one grade 3 rectal toxicity (rectorragia) (in "RT group") and one grade 4 (in "RT-CT group") were observed. One patient ("RT-CT group") presented a late grade 3 rectal toxicity (evaluated only for patients with at least 12 months of follow-up). Conclusions. - Concomitant radiochemotherapy followed by brachytherapy showed an acceptable toxicity profile, and seems to be adapted in selected elderly patients. It could be recommended as reference treatment in elderly patients with a good physiological status. (C) 2011 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved,