A ten year review of anal cancer management in Northern Ireland

TITLE: A 10-year Review of Anal Cancer Management in Northern Ireland PRESENTATION TYPE: Poster CURRENT CATEGORY: Chemoradiotherapy ABSTRACT BODY: Background to the Audit : Anal squamous cell cancer affects approximately 1100 patients in the UK annually.Outcomes for surgery and chemoradiotherapy (CRT) are comparable with CRT being the preferred modality to improve colostomy free survival. Large radiation pelvic fields can lead to increased acute toxicity and long term treatment related sequelae. Standard, Indicator and Target: Based on RCR guidance1 and ACT-II trial2.Time from consent to commencement of CRT <28 days, completion of RT with <7 days delay(100%).Colostomy rate for treatment morbidity(2%). Methodology: A retrospective review of electronic and patient records referred for anal cancer management 200211.Patient demographics, tumour characteristics, treatment modality and clinical outcomes were recorded. Results of 1st Audit Round : 168 patients were audited.(M=71,F=97).Median age 58(27-85).141 patients were considered for radical treatment. 113 patients had CRT (80.1%),17 had surgery only (12%),the remainder had RT only,or surgery+RT. Median time from consent to CRT was 18 days (1-56),91.3% of patients commenced within 28 days, the remaining delays were all due to co-morbid events. 12 patients had defunctiong stomas (3 were reversed), 4 patients had treatment related stomas (3.54%). 2 patients with HIV completed CRT without interrruption.13/15 patients aged >70 completed full dose CRT.Median OS 9.05 yrs,11.17 years for CRT group. 2-yr OS 79.7% all, 88.1% for radical patients.5.8% of CRT patients had delays >7days to completion. 1st Action Plan: Outcomes are comparable to published data.Chemotherapy protocols have been updated with omission of HIV specific and elderly/frail regimens. A prospective audit of toxicity/outcomes with IMRT treatment is proposed.An anal cancer working group has been set-up to implement IMRT for anal cancer managment in Northern Ireland. References: 1. The timely delivery of radical radiotherapy: standards and guidelines for the management of unscheduled treatment interruptions, Third Edition, 2008. RCR 2. Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open label, 2x2 factorial trial. James RD et al. (2013) Lancet Oncol ;14:516-24