What is the treatment for a 71-year-old patient with Squamous Cell Carcinoma (SCC) of the anorectal junction, with localized disease?

From the Guidelines

The recommended treatment for a 71-year-old patient with localized squamous cell carcinoma (SCC) of the anorectal junction is concurrent chemoradiation therapy, as supported by the most recent guidelines from the National Comprehensive Cancer Network (NCCN) 1. This approach typically consists of external beam radiation therapy (EBRT) delivered at a total dose of 50-54 Gy over 5-6 weeks, with concurrent chemotherapy using 5-fluorouracil (5-FU) and mitomycin C. Some key points to consider in the management of this patient include:

• Complete staging with physical examination, endoscopic evaluation, CT or MRI of the pelvis, and CT of the chest and abdomen to rule out metastatic disease.
• Weekly monitoring for toxicities including radiation dermatitis, proctitis, diarrhea, and myelosuppression.
• Supportive care with topical agents for skin reactions, anti-diarrheals, and pain management as needed.
• Assessment for response at 8-12 weeks with physical examination and imaging, with complete clinical response occurring in 70-90% of patients, allowing for observation without surgery.
• Consideration of salvage abdominoperineal resection for persistent or recurrent disease. This approach is preferred because it offers high cure rates while preserving anal function and quality of life in most patients, as noted in recent studies and guidelines 1.

From the Research

Treatment Options for Squamous Cell Carcinoma (SCC) of the Anorectal Junction

• The treatment for a 71-year-old patient with localized Squamous Cell Carcinoma (SCC) of the anorectal junction may involve chemoradiation therapy and local surgical excision, as seen in a study of anorectal Buschke-Löwenstein tumor with SCC transformation 2.
• Chemoradiation therapy with capecitabine and mitomycin-C has been shown to be effective in treating localized SCC of the anal canal, with a locoregional control rate of 86% at 6 months 3.
• A study comparing capecitabine and 5-fluorouracil (5-FU) in combination with simultaneous integrated boost intensity-modulated radiation therapy for anal cancer found that both treatments were effective, with a progression-free survival rate of 80% for 5-FU and 75% for capecitabine at 3 years 4.
• Local chemotherapy may be considered as an adjuvant treatment for unresectable SCC, either alone or in combination with radiotherapy or systemic chemotherapy, although resection of the lesion remains the gold standard treatment 5.
• A preliminary report from 1980 demonstrated the effectiveness of combined treatment with radical radiation therapy, 5-fluorouracil, and mitomycin-C in achieving local tumor control and retaining anal continence in patients with operable SCC of the anal canal 6.

Chemoradiation Therapy Regimens

• One possible chemoradiation therapy regimen for localized SCC of the anorectal junction is 45 Gy to the pelvis plus a boost with 14.40 Gy to the primary tumor, combined with mitomycin-C and 5-fluorouracil 2.
• Another regimen is capecitabine 825 mg/m(2) bid during radiotherapy, associated with a single dose of mitomycin 15 mg/m(2) on day 1 3.
• The choice of chemoradiation therapy regimen may depend on the specific characteristics of the patient and the tumor, as well as the availability of certain treatments.

Local Surgical Excision

• Local surgical excision may be considered as a treatment option for localized SCC of the anorectal junction, either alone or in combination with chemoradiation therapy 2.
• The goal of local surgical excision is to remove the tumor while preserving anal function and avoiding the need for a permanent colostomy.