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PTU-213 Oncological outcomes following local excision with and without (chemo)-radiotherapy for anal margin squamous cell carcinoma
  1. TF Bullen1,
  2. G Nanayakkara1,
  3. L Malcomson2,
  4. MP Saunders3,
  5. R Kochhar4,
  6. B Chakrabarty5,
  7. PE Fulford1,
  8. MS Wilson1,
  9. ST O’Dwyer,
  10. AG Renehan
  1. 1Department of Surgery, The Christie Hospital
  2. 2University of Manchester
  3. 3Department of Clinical Oncology, The Christie Hospital
  4. 4Department of Radiology
  5. 5Department of Pathology, The Christie Hospital, Manchester, UK

Abstract

Introduction The mainstay of treatment for anal squamous cell carcinoma (ASCC) is chemo-radiotherapy (CRT). Less than 5% of initial presentations are confined to the anal margin and amenable to local excision (LE) with or without post-operative (C)RT. However, treatment is poorly defined and outcome is understudied.

Method PLATO is the next UK anal cancer trial; a three-part umbrella trial where the first stream (ACT 3) is a phase II study to assess the use of LE, for T1N0 anal margin tumours, combined with low-dose post-operative CRT (41.4Gy in 23 fractions) for close margins (≤ 1 mm), evaluated against a minimally tolerated loco-regional actuarial relapse rate of 10%. To inform this trial, we report the characteristics, treatment and outcomes of patients treated through a large anal cancer MDT (2004 to 2013), supplemented by a literature review.

Results From 446 patients with new ASSC, there were 20 (4%) anal margin tumours treated by LE. Thirteen (65%) were T1; 7 (35%) were T2. All were N0 and M0. The lateral and deep margins were close (≤ 1 mm) in seven patients (35%). Five patients had additional therapy: 2 RT; 3 CRT. With a median follow-up of 38.6 months, there were no primary site recurrences; 3 patients developed nodal relapses (3-year loco-regional relapse = 11%). Three patients died attributed to their disease – the 3-year disease-free survival rate was 89%. The literature search identified six studies – there was a near total paucity of data on tumour characteristics, excision margin status, and the impact of these on subsequent treatment or outcome.

Conclusion There is a need for a contemporaneous prospective study of this sub-population of patients with anal cancer, through centralisation of patients to anal cancer MDTs with pro-active identification and recruitment of these patients for the ACT3 trial.

Disclosure of interest None Declared.

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