Variation in the Use of Chemoradiotherapy for Stage II and III Anal Cancer: Analysis of the National Cancer Data Base
Treatment for anal canal cancer has evolved from radical operations to definitive chemoradiotherapy (CRT), which allows for sphincter preservation in most patients.
The aim of this study was to examine the use of CRT for patients with stage II and III anal cancer, among different patient demographics, geographic regions, and facility types.
Utilizing the National Cancer Data Base, we examined patients with stage II and III anal canal squamous cell carcinoma from 2003 to 2010. Via univariate analysis, we examined patterns of treatment by patient demographics, tumor characteristics, geographic region, and facility type (academic vs. community). A multivariable logistic regression model was built to evaluate differences in treatment patterns when adjusting by age, sex, race, comorbidities, and stage.
A total of 12,801 patients were analyzed, of which 11,312 (88 %) received CRT. After adjusting for confounders, CRT was less likely to be administered to males [odds ratio (OR) 0.61, 95 % confidence interval (CI) 0.54–0.69], Black patients (OR 0.70, 95 % CI 0.59–0.83), and those with multiple comorbidities (OR 0.60, 95 % CI 0.51–0.72). CRT was not as widely utilized in the West (OR 0.74, 95 % CI 0.59–0.93), and patients treated in academic-based centers were less likely to receive CRT (OR 0.81, 95 % CI 0.72–0.92). Improved median overall survival was observed when CRT was utilized (p = 0.008).
When controlling for age, sex, race, comorbidities, and stage, discrepancies in the use of CRT for anal cancer treatment exist between demographic subtypes, geographical regions, and facility types.
KeywordsOverall Survival Median Overall Survival National Comprehensive Cancer Network National Comprehensive Cancer Network Anal Cancer
The authors would like to thank Timur Mitin, MD, PhD, for his assistance with the critical review of this manuscript, and Mary Kwatkosky-Lawlor for her assistance with editing.
Cristina B. Geltzeiler, Vassiliki L. Tsikitis, Jong S. Kim, Charles R. Thomas Jr, Daniel O. Herzig, and Kim C. Lu have no disclosures or conflicts of interest to report. This work was a podium presentation at the Northwest Society of Colon and Rectal Surgeons Annual Meeting, Lake Tahoe, CA, USA, 12–15 August 2015.
- 2.American Cancer Society. Anal cancer. 2013. Available at http://www.cancer.org/cancer/analcancer/detailedguide/anal-cancer-what-is-key-statistics. Accessed 12 Mar 2016.
- 5.Bartelink H, Roelofsen F, Eschwege F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol. 1997;15(5):2040–49.PubMedGoogle Scholar
- 8.National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: anal carcinoma. 2014. Available at http://www.nccn.org/professionals/physician_gls/pdf/anal.pdf. Accessed 12 Mar 2016.
- 10.National Cancer Data Base. National Cancer Data Base. 2015. Available at https://www.facs.org/quality%20programs/cancer/ncdb. Accessed 12 Mar 2016.
- 18.Gunderson LL, Winter KA, Ajani JA, et al. Long-term update of US GI intergroup RTOG 98-11 phase III trial for anal carcinoma: survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomycin versus fluorouracil/cisplatin. J Clin Oncol. 2012;30(35):4344–51.CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Centers for Disease Control and Prevention. HIV surveillance report: diagnoses of HIV infection in the United States and dependent areas. 2014. Available at http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf. Accessed 1 May 2016.
- 27.Kachnic LA, Winter K, Myerson RJ, et al. RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys. 2013;86(1):27–33.CrossRefPubMedGoogle Scholar