KEY POINTS
- The DKTK-ROG multicentre retrospective study included 683 patients with localized anal squamous cell carcinoma treated with curative-intent chemoradiotherapy at eight German tertiary centres between 2004 and 2018. 180 patients (26%) were aged ≥70 years, with a median age of 76 years.
- Treatment was primarily 5-FU/mitomycin C-based chemoradiotherapy, with capecitabine allowed according to institutional practice. Radiotherapy used 3D-CRT, IMRT or VMAT, and all included patients received at least 40 Gy EQD2 to the primary tumour.
- Across the entire cohort, 3-year freedom from recurrence was 80.0% (95% CI 76.9-83.3%) and overall survival was 87.1% (95% CI 84.5-89.9%).
- Older patients had no significant difference in locoregional failure, distant metastasis or freedom from recurrence compared with younger patients. Competing-risk analysis likewise showed no excess locoregional failure (HR 0.84, 95% CI 0.53-1.33, p=0.5) or distant metastasis (HR 0.98, 95% CI 0.58-1.67, p=0.9).
- Overall survival was significantly worse in patients aged ≥70. On multivariable analysis, older age remained independently associated with mortality (HR 2.51, 95% CI 1.73-3.64, p<0.001), supporting competing mortality rather than poorer cancer control as the main explanation.
- Tumour biology remained more important for recurrence than age. cT4 disease carried an HR of 8.04 (95% CI 2.92-22.09, p<0.001) for recurrence, while node-positive disease carried an HR of 1.95 (95% CI 1.33-2.86, p<0.001).
- Treatment took slightly longer in older patients, with median overall treatment time 45 versus 44 days (p=0.002) and treatment >45 days in 47.2% versus 32.0% (p<0.001). This prolongation was not independently associated with worse recurrence control. The study lacked formal frailty or geriatric assessment and excluded patients considered too unfit for chemotherapy, limiting generalization to all older patients.
Note: the manuscript consistently reports no association between age and recurrence, but gives the multivariable FFR HR as 1.04 in the abstract and 1.14 in the Results/Table 3, with the same 95% CI and p value. I would avoid putting that HR on the public card unless corrected in the final version.
CLINICAL TAKEAWAY
Chronological age alone should not be used to deny definitive chemoradiotherapy to a fit older patient with localized anal cancer. These data support curative treatment in carefully selected patients ≥70, while also showing why formal geriatric assessment would be more informative than age alone.