Clinical Outcomes and Toxicity Profile of Chemoradiotherapy in Older Versus Younger Patients With Anal Cancer: A Retrospective Cohort Analysis

Abstract

Aims

The optimal management of older patients with anal cancer (AC) receiving chemoradiotherapy (CRT) remains controversial, particularly regarding treatment tolerance and outcomes. This study aimed to compare treatment outcomes and toxicity profiles between older and younger patients undergoing standard CRT.

Materials and methods

We conducted a 16-year retrospective analysis of AC patients treated with CRT at our institution between 2008 and 2023. A total of 61 patients were stratified into older (≥65 years, n = 25) and younger (<65 years, n = 36) patients. The primary objectives were to compare clinicopathological characteristics, treatment patterns, and outcomes between age groups, as well as to identify prognostic factors in patients with nonmetastatic squamous cell carcinoma of the anus (SCCA). Treatment toxicities were evaluated according to Common Terminology Criteria for Adverse Events (CTCAE). Survival analysis included overall survival (OS), locoregional recurrence-free survival (LRFS), metastasis-free survival (MFS), and progression-free survival (PFS). Analyses of survival curves were performed using the Kaplan-Meier method. Statistical significance was set at P < 0.05.

Results

After a median follow-up of 48 months (range, 6-187), complete response rates were 86.7% and 95.2% in younger and older cohorts, respectively (P = .395). At the 48-month median follow-up, 4-year OS was 72.3% in younger and 68.7% in older patients (P = .845). Four-year LRFS (77.7% vs 88.7%, P = .381), MFS (83.8% vs 93.3%, P = .718), and PFS (77.7% vs 89.3%, P = .656) showed no significant differences between cohorts. Completion of treatment reached 100% and 98% in younger and older groups. A pretreatment haemoglobin <11.7g/dL and an SCC ≥1.3 ng/mL were significant prognostic factors in the younger cohort only (P = .026 and P = .016, respectively).

Conclusion

Older patients with AC demonstrate comparable treatment outcomes to younger patients when receiving curative-intent CRT. With comparable complete response rates, survival outcomes, and high completion of treatment between age cohorts, our results demonstrate that carefully managed CRT is both feasible and effective in older patients.