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Multimodal Therapy of Squamous Cell Carcinoma of the Anus With Distant Metastasis: A Single-Institution Experience

Evesque, Ludovic M.D.1; Benezery, Karen M.D.2; Follana, Philippe M.D.1; Tuan Falk, Alexander M.D.2; Doyen, Jerome M.D.2; Reure, Juliette M.D.1; Cavaglione, Gerard M.D.1; François, Eric M.D.1

Diseases of the Colon & Rectum: August 2017 - Volume 60 - Issue 8 - p 785–791
doi: 10.1097/DCR.0000000000000827
Original Contributions: Colorectal/Anal Neoplasia
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BACKGROUND: Because of the rarity of the condition, studies concerning the management of patients with squamous cell carcinoma of the anus with distant metastasis are scarce. The available studies indicate poor outcomes with exclusive chemotherapy.

OBJECTIVE: Our aim was to evaluate the impact of multidisciplinary treatment on overall survival among patients presenting with metastatic squamous cell carcinoma of the anus.

DESIGN: This was a retrospective study.

SETTINGS: The study was conducted at a single French institution between 2000 and 2014.

PATIENTS: Consecutive patients with histologically proven, newly diagnosed, or recurrent metastatic squamous cell carcinoma of the anus were included.

INTERVENTIONS: Study interventions included multimodal therapy combining systemic chemotherapy and local ablative treatment to remove all metastases through surgery, radiofrequency ablation, or radiotherapy.

MAIN OUTCOME MEASURES: The primary outcome measure was overall survival.

RESULTS: Fifty patients (median age, 62 years; men/women: 8/42) fulfilled the inclusion criteria, and 39 were available for Response Evaluation Criteria in Solid Tumors. Forty had metastatic relapse after previous treatment of localized disease, and 10 presented with synchronous metastasis. P16 status was not available. Patients received at least 1 chemotherapy regimen, including 5-fluorouracil–mitomycin C (n = 22), cisplatin–5-fluorouracil (n = 20), or 5-fluorouracil alone (n = 3). Thirteen also had surgical metastasectomy, 11 had radiotherapy, and 6 had radiofrequency ablation. Median overall survival was 20.0 months (95% CI, 18.2–21.8 mo), and median time to failure of strategy was 6.0 months (95% CI, 2.9–9.1 mo). Overall response rate was 56% (95% CI, 40%–73%). Outcomes from the 5-fluorouracil–mitomycin C and cisplatin regimens did not statistically differ. Patients treated with multimodal therapy had a median overall survival of 22.0 months (95% CI, 15.3–28.6 mo) versus 13.0 months (95% CI, 9.5–16.5 mo; p = 0.002). Median time to failure of strategy was 10.0 months (95% CI, 4.2–15.7 mo) versus 5.0 months (95% CI, 2.8–7.2; p = 0.007). After 2 years, 40% of patients with multimodal treatment and 20% of those without ablative treatment were alive.

LIMITATIONS: This study is limited by its retrospective design and modest sample size.

CONCLUSIONS: Stage IV squamous cell carcinoma of the anus outcomes are poor, but first-line chemotherapy can enable good response rates. Other treatment modalities, including surgery, radiotherapy, and thermoablation, should be considered, because they may provide a survival advantage. See Video Abstract at

1 Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France

2 Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France

Funding/Support: None reported.

Financial Disclosure: None reported.

Correspondence: Ludovic Evesque, M.D., Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice Cedex 2, France. E-mail:

© 2017 The American Society of Colon and Rectal Surgeons