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Treatment of Stages I-III Squamous Cell Anal Cancer: A Comparative Effectiveness Systematic Review.
Troester, Alexander; Parikh, Romil; Southwell, Bronwyn; Ester, Elizabeth; Sultan, Shahnaz; Greeno, Edward; Arsoniadis, Elliot; Church, Timothy R; Wilt, Timothy; Butler, Mary; Goffredo, Paolo.
Afiliación
  • Troester A; Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
  • Parikh R; School of Public Health, University of Minnesota, Minneapolis, MN, USA.
  • Southwell B; Department of Anesthesia, University of Minnesota, Minneapolis, MN, USA.
  • Ester E; Division of Radiation Oncology, Department of Radiology, University of Minnesota, Minneapolis, MN, USA.
  • Sultan S; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
  • Greeno E; Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
  • Arsoniadis E; Division of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
  • Church TR; School of Public Health, University of Minnesota, Minneapolis, MN, USA.
  • Wilt T; Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
  • Butler M; Minneapolis VA Center for Care Delivery and Outcomes Research and the University of Minnesota Schools of Medicine and Public Health, Minneapolis, MN, USA.
  • Goffredo P; School of Public Health, University of Minnesota, Minneapolis, MN, USA.
J Natl Cancer Inst ; 2024 Aug 20.
Article en En | MEDLINE | ID: mdl-39163501
ABSTRACT

PURPOSE:

To assess the effectiveness and harms of initial treatment strategies for stages I-III anal squamous cell cancer (SCC).

METHODS:

We searched Medline®, Embase®, and CENTRAL®, between January 1, 2000- March 2024, for randomized controlled trials and nonrandomized studies of interventions comparing initial treatment strategies. Individual study risk of bias (RoB) and overall strength of evidence (SOE) were evaluated for a prespecified outcome list using standardized methods.

RESULTS:

We identified 33 eligible studies and extracted data. Six were deemed low/moderate RoB. Compared with radiotherapy (RT) alone, chemoradiotherapy (CRT) with 5-fluorouracil (FU) and mitomycin C (MMC) probably shows a benefit in locoregional failure (LRF), disease-specific (DSS), and colostomy-free survival (CFS) (moderate SOE) yet may result in greater overall and acute hematologic toxicity, with no difference in late harms (low SOE). CRT with 5FU+MMC may show a benefit in LRF, DSS, and CFS rates compared with 5FU alone (low SOE). CRT with 5FU+cisplatin vs 5FU+MMC probably results in no differences in several effectiveness outcomes or overall acute or late harms, and probably increases hematologic toxicity with MMC (moderate SOE). Compared with CRT using capecitabine+MMC, CRT with capecitabine+MMC+paclitaxel may improve OS, DSS, and CFS, yet cause more acute harms (low SOE). Evidence was insufficient for remaining comparisons.

CONCLUSIONS:

CRT with 5FU+MMC or 5FU+cisplatin is likely more effective yet incurs greater acute hematologic toxicity than RT alone or single-agent CRT. Adding paclitaxel to capecitabine+MMC may increase treatment efficacy and toxicity. Evidence is insufficient comparing post-treatment surveillance strategies and patient-reported outcomes, highlighting research opportunities.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Natl Cancer Inst Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Natl Cancer Inst Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos