Glynne-Jones, R;
Meadows, HM;
Lopes, A;
Muirhead, R;
Sebag-Montefiore, D;
Adams, R;
ACTII study group;
(2020)
Impact of compliance to chemoradiation on long-term outcomes in squamous cell carcinoma of the anus. Results of a post-hoc analysis from the randomized phase III ACT II trial.
Annals of Oncology
, 31
(10)
pp. 1376-1385.
10.1016/j.annonc.2020.06.012.
Preview |
Text
Meadows_Impact of compliance to chemoradiation on long-term outcomes in squamous cell carcinoma of the anus_Pre-proof.pdf - Accepted Version Download (1MB) | Preview |
Abstract
PURPOSE: Concurrent chemoradiation is standard-of-care for patients with squamous cell carcinoma of the anus (SCCA). Poor compliance to chemotherapy, radiotherapy treatment interruptions and unplanned breaks may impact adversely on long-term outcomes. METHODS: The ACT II trial recruited 940 patients with localized SCCA, and assigned patients to mitomycin (week 1) or cisplatin (weeks 1 and 5), with fluorouracil (weeks 1 & 5) and radiotherapy (50·4Gy in 28 fractions over 38 days). This post-hoc analysis examined the association between baseline factors (age, gender, site, T-stage and N-stage), and compliance to treatment (radiotherapy and chemotherapy), and their effects on loco-regional failure-free survival (LRFFS), progression-free survival (PFS) and overall survival (OS). Compliance was categorized into groups. Radiotherapy: 6 groups according to total dose (TD) and overall treatment time (OTT). Chemotherapy: 3 groups (A = per-protocol; B = dose reduction or delay; C = omitted). RESULTS: 931/940 patients were evaluable for radiotherapy and 936 for chemotherapy compliance. Baseline Glomerular filtration rate (GR) <60 mL/min and cisplatin were significantly associated with poor week 5 compliance to chemotherapy (p 0.003 and 0.02, respectively). Omission of week 5 chemotherapy was associated with significantly worse LRFFS (HR 2.53 [1.33 to 4.82] p=0.005). Dose reductions/delays or omission of week 5 chemotherapy were associated with significantly worse FPFS (HR: 1.56 [95%CI: 1.18-2.06], p=0.002 and HR: 2.39 [95%CI: 1.44-3.98}, p=0.001, respectively) and OS (HR: 1.92 [95%CI: 1.41-2.63], p<0.001 and (HR: 2.88 [95%CI: 1.63-5.08], p<0.001, respectively). Receiving the target radiotherapy dose in >42 days is associated with worse PFS and OS (HR:1.72 (95%CI:1.17-2.54), p=0.006). CONCLUSION: Poor compliance to chemotherapy and radiotherapy were associated with worse LRFFS, PFS and OS. Treatment interruptions should be minimized, and OTT and TD maintained.
| Type: | Article |
|---|---|
| Title: | Impact of compliance to chemoradiation on long-term outcomes in squamous cell carcinoma of the anus. Results of a post-hoc analysis from the randomized phase III ACT II trial |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.annonc.2020.06.012 |
| Publisher version: | https://doi.org/10.1016/j.annonc.2020.06.012 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Squamous cell carcinoma of the anus, chemoradiation, chemotherapy, combined modality, compliance, radiotherapy |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > CRUK Cancer Trials Centre |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10104416 |
Archive Staff Only
 |
View Item |
