Front Oncol. 2026 May 19;16:1761654. doi: 10.3389/fonc.2026.1761654. eCollection 2026.
ABSTRACT
BACKGROUND: Chemoradiotherapy (CRT) is the standard treatment for squamous cell carcinoma of the anal canal (ACC), achieving excellent local control and sphincter preservation. However, many long-term survivors experience persistent bowel, urinary, sexual, and psycho social sequelae affecting quality of life (QoL). The PROACT study (Patient – Reported Outcomes in Anal Cancer Patients Treated with Intensity-Modulated Radiotherapy; NCT06364579) wants to explore the relationship between oncologic outcomes and patient-reported QoL in the era of modern radiotherapy.
METHODS: This single-institution ambispective study included patients with a diagnosis of ACC treated between 2011 and 2024 with intensity modulated radiotherapy (IMRT)-based CRT, followed-when indicated-by an image guided interventional radiotherapy (IRT) boost. Oncologic outcomes and toxicity were assessed using standard criteria. QoL was evaluated annually up to 5 years post-treatment using the EORTC QLQ-C30 and anal cancer-specific QLQ-ANL27 questionnaires. Statistical analyses explored associations between QoL domains and patient-, disease-, and treatment-related factors.
RESULTS: Median age was 62 years (range 34-83); 82.2% were female. Median follow-up was 51 months. Three- and five-year overall survival were both 97.5%. Disease-free survival was 88.2% and 84.5% at three and five years, respectively, while locoregional relapse-free survival was 92.8% and 89.0%. Colostomy-free survival showed identical rates at three and five years (97.3%). Late≥ G3 Gastrointestinal toxicity occurred in 6 patients (6.7%). Compared with the general population, both sexes reported significantly higher global QoL (males p = 0.002; females p = 0.001), while diarrhea was worst in women (p = 0.0008). Younger age (<70 years), female sex, and late GI toxicity correlated with poorer functional outcomes, particularly in bowel and sexual domains.
CONCLUSIONS: PROACT underscores that treatment success in anal cancer extends beyond cure, encompassing survivorship, functionality, and well-being. Integrating oncologic and patient-reported outcomes offers a comprehensive, patient-centered framework for optimizing long-term care.
PMID:42239889 | PMC:PMC13225979 | DOI:10.3389/fonc.2026.1761654
