NEW YORK (Reuters Health) Aug 10 - Radiotherapy for anal cancer can preserve anal function but many patients are still left with a colostomy, Danish researchers report.
"We can't promise patients they will avoid a colostomy," Dr. Kare G. Sunesen from Aarhus University Hospital, Aalborg told Reuters Health in an email.
Dr. Sunesen and colleagues examined cause-specific colostomy rates (tumor-related or therapy-related) following curative-intent radiotherapy or chemoradiotherapy in 235 patients with anal cancer treated at four medical centers.
At five years, 26% of patients had tumor-related colostomies, and 8% had therapy-related colostomies. The combined incidence of colostomies and death was 49%.
All but one of 20 pretreatment tumor-related colostomies remained in place after radiotherapy, and that patient required a second colostomy as a result of fecal incontinence.
"Patients should be informed that a pretreatment colostomy is usually permanent," the investigators say in their report, published online August 8th in the Journal of Clinical Oncology.
Most of the tumor-related colostomies (57 of 64, or 89%) were created within the first two years after radiotherapy and all but three were necessary within 5 years.
All 18 therapy-related colostomies were created with five years of radiotherapy, and 15 (83%) were done within two years.
Larger tumors, especially those 6 cm and larger, were associated with a significantly increased risk for tumor-related colostomy.
Patients with a local excision or excisional biopsy before radiotherapy had more than a four-fold higher incidence of therapy-related colostomy after radiotherapy compared to patients who didn't have these procedures.
"These findings suggest that a local excision should not be the primary therapeutic option, even for small tumors," the researchers note.
"Primary (chemo) radiotherapy for anal cancer offers the opportunity of cure from cancer while at the same time preserving normal anal function," Dr. Sunesen said. "Still, patients should be informed that a substantial proportion will eventually need a permanent colostomy after treatment, either because of treatment toxicity or recurrence of anal cancer."
"We are currently investigating how the radiotherapy dose and the patient's individual sensitivity to radiation impact anorectal function after radiotherapy for pelvic malignancies, including anal cancer," Dr. Sunesen added. "In addition, we are examining if sacral nerve stimulation (SNS) can reduce symptoms in patients with severe anorectal disturbances after radiotherapy, such as incontinence, and, consequently, reduce the need for colostomy."
SOURCE: http://bit.ly/ojd0Ff
J Clin Oncol 2011.
"We can't promise patients they will avoid a colostomy," Dr. Kare G. Sunesen from Aarhus University Hospital, Aalborg told Reuters Health in an email.
Dr. Sunesen and colleagues examined cause-specific colostomy rates (tumor-related or therapy-related) following curative-intent radiotherapy or chemoradiotherapy in 235 patients with anal cancer treated at four medical centers.
At five years, 26% of patients had tumor-related colostomies, and 8% had therapy-related colostomies. The combined incidence of colostomies and death was 49%.
All but one of 20 pretreatment tumor-related colostomies remained in place after radiotherapy, and that patient required a second colostomy as a result of fecal incontinence.
"Patients should be informed that a pretreatment colostomy is usually permanent," the investigators say in their report, published online August 8th in the Journal of Clinical Oncology.
Most of the tumor-related colostomies (57 of 64, or 89%) were created within the first two years after radiotherapy and all but three were necessary within 5 years.
All 18 therapy-related colostomies were created with five years of radiotherapy, and 15 (83%) were done within two years.
Larger tumors, especially those 6 cm and larger, were associated with a significantly increased risk for tumor-related colostomy.
Patients with a local excision or excisional biopsy before radiotherapy had more than a four-fold higher incidence of therapy-related colostomy after radiotherapy compared to patients who didn't have these procedures.
"These findings suggest that a local excision should not be the primary therapeutic option, even for small tumors," the researchers note.
"Primary (chemo) radiotherapy for anal cancer offers the opportunity of cure from cancer while at the same time preserving normal anal function," Dr. Sunesen said. "Still, patients should be informed that a substantial proportion will eventually need a permanent colostomy after treatment, either because of treatment toxicity or recurrence of anal cancer."
"We are currently investigating how the radiotherapy dose and the patient's individual sensitivity to radiation impact anorectal function after radiotherapy for pelvic malignancies, including anal cancer," Dr. Sunesen added. "In addition, we are examining if sacral nerve stimulation (SNS) can reduce symptoms in patients with severe anorectal disturbances after radiotherapy, such as incontinence, and, consequently, reduce the need for colostomy."
SOURCE: http://bit.ly/ojd0Ff
J Clin Oncol 2011.
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