Anal carcinoma of the elderly treated with radiotherapy alone or with concomitant radio-chemotherapy

Purpose: To analyse the results achieved with radio-chemotherapy (RTCT) or radiotherapy alone (RT) in elderly patients (pts) affected with squamous cell anal cancer. Methods and materials: From 1990 to 2002, 62 pts aged ≥70 years were treated with RT (14) or RTCT (48). There were 9 stage I, 29 stage II, 11 stage IIIa and 13 stage IIIb. MMC + 5FU was given concomitantly with RT in an early period, later replaced by Cddp + 5FU. In the RTCT group, 36 Gy were delivered to pelvic + inguinal lymph nodes, with a tumor boost (18 Gy). Results: Stage II fared significantly better than stage III in terms of locoregional control (LRC) but not overall survival (OS). Pts treated with RTCT had improved LRC, but not OS. LRC was 81% at 3 and 5 years for the RTCT group; the RT group had a LRC of 61% at 3 years. There were more locoregional relapses in the MMC group (29%) versus the Cddp group (19%) and in pts treated with a split (32%) versus no split (19%). No G3 acute toxicity was observed in the RT group; in the RTCT group 15 pts (31%) developed a G3+ acute toxicity. G3+ late damage occurred in 2 pts in the RT only group and in 3 pts in the RTCT group. Conclusions: Elderly people considered fit for RTCT should undergo the same schedules used for younger people. MMC or Cddp + 5FU are feasible in the elderly, even without a planned split.