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To the Editor: Dr Ajani and colleagues¹ compared a combination of fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for the treatment of anal canal carcinoma. The 2 study groups had similar levels of toxicity, and the adherence to both chemotherapy and radiotherapy was comparable. However, there were some differences in treatment results.

One possible explanation for the significantly better time to colostomy in the standard treatment group is not linked to the chemotherapy itself, but rather to the immediate starting of radiotherapy. In the experimental group, radiation was delayed for almost 2 months. The importance of immediate combined treatment has been shown for laryngeal cancer² and may also be true for anal carcinoma, which is especially sensitive to radiotherapy.³

Financial Disclosures: None reported.

Daniela Musio, MD; Giovanni Codacci-Pisanelli, MD
oncologialatina@uniroma1.it
Department of Experimental Medicine
Università La Sapienza
Rome, Italy

1. Ajani JA, Winter KA, Leonard L; et al. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA. 2008;299(16):1914-1921. FREE FULL TEXT 2. Forastiere AA, Goepfert H, Maor M; et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349(22):2091-2098. FREE FULL TEXT 3. Martenson JA Jr, Gunderson LL. External radiation therapy without chemotherapy in the management of anal cancer. Cancer. 1993;71(5):1736-1740. FULL TEXT | WEB OF SCIENCE | PUBMED

Letters Section Editor: Robert M.Golub, MD, Senior Editor.

JAMA. 2008;300(12):1410-1411.

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RELATED ARTICLE

Fluorouracil, Mitomycin, and Radiotherapy vs Fluorouracil, Cisplatin, and Radiotherapy for Carcinoma of the Anal Canal: A Randomized Controlled Trial
Jaffer A. Ajani, Kathryn A. Winter, Leonard L. Gunderson, John Pedersen, Al B. Benson, III, Charles R. Thomas, Jr, Robert J. Mayer, Michael G. Haddock, Tyvin A. Rich, and Christopher Willett
JAMA. 2008;299(16):1914-1921.
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RELATED LETTER

Chemotherapy and Radiotherapy for Anal Canal Carcinoma—Reply
Jaffer A. Ajani, Kathryn A. Winter, and Leonard L. Gunderson
JAMA. 2008;300(12):1411.
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