Evidence map›Paper›PMID 39163501›Full record

SynthesisJournal of the National Cancer Institute2025

Treatment of stage I-III squamous cell anal cancer: a comparative effectiveness systematic review.

Alexander Troester, Romil Parikh, Bronwyn Southwell, Elizabeth Ester, Shahnaz Sultan, Edward Greeno, Elliot Arsoniadis, Timothy R Church, Timothy Wilt, Mary Butler and 1 more

Abstract readSystematic ReviewComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of the National Cancer Institute, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Alexander TroesterDepartment of Surgery, University of Minnesota, Minneapolis, MN, USA.ORCID 0000-0001-9182-5814
Romil ParikhSchool of Public Health, University of Minnesota, Minneapolis, MN, USA.
Bronwyn SouthwellDepartment of Anesthesia, University of Minnesota, Minneapolis, MN, USA.
Elizabeth EsterDivision of Radiation Oncology, Department of Radiology, University of Minnesota, Minneapolis, MN, USA.
Shahnaz SultanDivision of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Edward GreenoDivision of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.ORCID 0000-0002-9272-6161
Elliot ArsoniadisDivision of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Timothy R ChurchSchool of Public Health, University of Minnesota, Minneapolis, MN, USA.
Timothy WiltMinneapolis VA Center for Care Delivery and Outcomes Research and the University of Minnesota Schools of Medicine and Public Health, Minneapolis, MN, USA.
Mary ButlerSchool of Public Health, University of Minnesota, Minneapolis, MN, USA.
Paolo GoffredoDivision of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.ORCID 0000-0001-7078-6625

Funding

AHRQHHSPatient-Centered Outcomes Research Institute 75Q80120D00008
6 · The paper itself

Abstract

backgroundWe sought to assess the effectiveness and harms of initial treatment strategies for stage I through III anal squamous cell anal cancer.

methodsWe searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials between January 1, 2000, and March 2024, for randomized controlled trials and nonrandomized studies of interventions comparing initial treatment strategies. Individual study risk of bias and overall strength of evidence were evaluated for a prespecified outcome list using standardized methods.

resultsWe identified 33 eligible studies and extracted data. Six were deemed low to moderate risk of bias. Compared with radiation therapy alone, chemoradiation therapy (CRT) with 5-fluorouracil (5-FU) and mitomycin C probably shows a benefit in locoregional failure, disease-specific survival, and colostomy-free survival (moderate strength of evidence) yet may result in greater overall and acute hematological toxicity, with no difference in late harms (low strength of evidence). CRT with 5-FU plus mitomycin C may show a benefit in locoregional failure, disease-specific survival, and colostomy-free survival rates compared with 5-FU alone (low strength of evidence). CRT with 5-FU plus cisplatin vs 5-FU plus mitomycin C probably results in no differences in several effectiveness outcomes or overall acute or late harms and probably increases hematological toxicity with mitomycin C (moderate strength of evidence). Compared with CRT using capecitabine plus mitomycin C, CRT with capecitabine plus mitomycin C and paclitaxel may improve overall survival, disease-specific survival, and colostomy-free survival yet cause more acute harms (low strength of evidence). Evidence was insufficient for remaining comparisons.

conclusionsCRT with 5-FU plus mitomycin C or 5-FU plus cisplatin is likely more effective yet incurs greater acute hematological toxicity than radiation therapy alone or single-agent CRT. Adding paclitaxel to capecitabine plus mitomycin C may increase treatment efficacy and toxicity. Evidence is insufficient comparing posttreatment surveillance strategies and patient-reported outcomes, highlighting research opportunities.

Indexed as

Antineoplastic Combined Chemotherapy ProtocolsAnus NeoplasmsCarcinoma, Squamous CellChemoradiotherapyCisplatinComparative Effectiveness ResearchFluorouracilHumansMitomycinNeoplasm StagingRandomized Controlled Trials as TopicTreatment OutcomeCisplatinFluorouracilMitomycin

Identifiers

PMID39163501
PMCPMC11807441

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.