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Anal carcinoma: impact of TN category of disease on survival, disease relapse, and colostomy failure in US Gastrointestinal Intergroup RTOG 98-11 phase 3 trial.

Publication ,  Journal Article
Gunderson, LL; Moughan, J; Ajani, JA; Pedersen, JE; Winter, KA; Benson, AB; Thomas, CR; Mayer, RJ; Haddock, MG; Rich, TA; Willett, CG
Published in: Int J Radiat Oncol Biol Phys
November 15, 2013

PURPOSE: The long-term update of US GI Intergroup RTOG 98-11 anal cancer trial found that concurrent chemoradiation (CCRT) with fluorouracil (5-FU) plus mitomycin had a significant impact on disease-free survival (DFS) and overall survival (OS) compared with induction plus concurrent 5-FU plus cisplatin. The intent of the current analysis was to determine the impact of tumor node (TN) category of disease on survival (DFS and OS), colostomy failure (CF), and relapse (local-regional failure [LRF] and distant metastases [DM]) in this patient group. METHODS AND MATERIALS: DFS and OS were estimated univariately by using the Kaplan-Meier method, and 6 TN categories were compared by the log-rank test (T2N0, T3N0, T4N0, T2N1-3, T3N1-3, and T4N1-3). Time to relapse and colostomy were estimated by the cumulative incidence method, and TN categories were compared using Gray's test. RESULTS: Of 682 patients, 620 were analyzable for outcomes by TN category. All endpoints showed statistically significant differences among the TN categories of disease (OS, P<.0001; DFS, P<.0001; LRF, P<.0001; DM, P=.0011; CF, P=.01). Patients with the poorest OS, DFS, and LRF outcomes were those with T3-4N-positive (+) disease. CF was lowest for T2N0 and T2N+ (11%, 11%, respectively) and worst for the T4N0, T3N+, and T4N+ categories (26%, 27%, 24%, respectively). CONCLUSIONS: TN category of disease has a statistically significant impact on OS, DFS, LRF, DM, and CF in patients treated with CCRT and provides excellent prognostic information for outcomes in patients with anal carcinoma. Significant challenges remain for patients with T4N0 and T3-4N+ categories of disease with regard to survival, relapse, and CF and lesser challenges for T2-3N0/T2N+ categories.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

November 15, 2013

Volume

87

Issue

4

Start / End Page

638 / 645

Location

United States

Related Subject Headings

  • Tumor Burden
  • Treatment Failure
  • Survival Analysis
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Mitomycin
  • Lymph Nodes
  • Humans
  • Fluorouracil
 

Citation

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Gunderson, L. L., Moughan, J., Ajani, J. A., Pedersen, J. E., Winter, K. A., Benson, A. B., … Willett, C. G. (2013). Anal carcinoma: impact of TN category of disease on survival, disease relapse, and colostomy failure in US Gastrointestinal Intergroup RTOG 98-11 phase 3 trial. Int J Radiat Oncol Biol Phys, 87(4), 638–645. https://doi.org/10.1016/j.ijrobp.2013.07.035
Gunderson, Leonard L., Jennifer Moughan, Jaffer A. Ajani, John E. Pedersen, Kathryn A. Winter, Al B. Benson, Charles R. Thomas, et al. “Anal carcinoma: impact of TN category of disease on survival, disease relapse, and colostomy failure in US Gastrointestinal Intergroup RTOG 98-11 phase 3 trial.Int J Radiat Oncol Biol Phys 87, no. 4 (November 15, 2013): 638–45. https://doi.org/10.1016/j.ijrobp.2013.07.035.
Gunderson LL, Moughan J, Ajani JA, Pedersen JE, Winter KA, Benson AB, et al. Anal carcinoma: impact of TN category of disease on survival, disease relapse, and colostomy failure in US Gastrointestinal Intergroup RTOG 98-11 phase 3 trial. Int J Radiat Oncol Biol Phys. 2013 Nov 15;87(4):638–45.
Gunderson, Leonard L., et al. “Anal carcinoma: impact of TN category of disease on survival, disease relapse, and colostomy failure in US Gastrointestinal Intergroup RTOG 98-11 phase 3 trial.Int J Radiat Oncol Biol Phys, vol. 87, no. 4, Nov. 2013, pp. 638–45. Pubmed, doi:10.1016/j.ijrobp.2013.07.035.
Gunderson LL, Moughan J, Ajani JA, Pedersen JE, Winter KA, Benson AB, Thomas CR, Mayer RJ, Haddock MG, Rich TA, Willett CG. Anal carcinoma: impact of TN category of disease on survival, disease relapse, and colostomy failure in US Gastrointestinal Intergroup RTOG 98-11 phase 3 trial. Int J Radiat Oncol Biol Phys. 2013 Nov 15;87(4):638–645.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

November 15, 2013

Volume

87

Issue

4

Start / End Page

638 / 645

Location

United States

Related Subject Headings

  • Tumor Burden
  • Treatment Failure
  • Survival Analysis
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Recurrence, Local
  • Mitomycin
  • Lymph Nodes
  • Humans
  • Fluorouracil