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. 2004;3(2):95-100.
doi: 10.1016/j.brachy.2004.06.003.

Treatment of T3 and T4 anal carcinoma with combined chemoradiation and interstitial 192Ir implantation: a 10-year experience

Julie M Hwang  1 , Aroor R Rao, Harry A Cosmatos, Ricardo Wang, John S Kaptein, Robert A Kagan, Jim Y Hsiang, Michael Tome
Affiliations

Treatment of T3 and T4 anal carcinoma with combined chemoradiation and interstitial 192Ir implantation: a 10-year experience

Julie M Hwang et al. Brachytherapy. 2004.

Abstract

Purpose: To report our experience in treating T3 and T4 anal carcinoma with combined external beam (EBRT) and chemotherapy, followed by interstitial (192)Ir implant boost.

Methods and materials: From 1990 to 2000, 31 patients with T3 and T4 anal carcinoma were treated with: 30 Gy EBRT (2 Gy fractions, 5 days/week) + 5-fluorouracil + mitomycin-C. Median implant dose was 31.3 Gy at 0.5 cm, delivered at a mean rate of 0.52 Gy/h.

Results: Six patients had local persistence and 4 eventually developed local-regional recurrence. Eight underwent abdomino-perineal resection (APR). With the addition of APR in selected cases, the ultimate local-regional control after initial treatment was 84%. Distant metastases occurred in 10. Of the initial cohort, 55% is still alive and NED. Eight had radiation proctitis and 7 developed postimplant ulceration. Only 1 required surgical intervention.

Conclusions: Treatment of T3 and T4 anal cancer with combined chemotherapy and EBRT, followed by interstitial implant results in an ultimate local-regional control of 84%, after the inclusion of selected APR. It is well tolerated, with acceptable toxicity.

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