Comparison of intravenous 5-Fluorouracil with Oral Capecitabine in the Treatment of Anal Squamous Cell Carcinoma Using Modern Radiation Techniques

Shir Schlosser, Svetlana Zalmanov, Raphael M. Pfeffer, Yoav Lipski, Vladislav Grinberg, Yael Kalmus, Daphne Levin, Keren Hod, Merav A. Ben David*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Anal squamous cell carcinoma (ASqCC) is a rare malignancy, traditionally treated with combined chemoradiation, with a continuous infusion of 5-fluorouracil (5-FU) and mitomycin C (MMC). Replacing intravenous (IV) 5-FU with oral capecitabine (oral fluoropyrimidine) has been reported as a non-inferior treatment option. However, these data are scarce, with variable results. Objectives: To examine the outcome of patients with ASqCC treated with either IV 5-FU or capecitabine concomitantly with radiation therapy. To compare treatment side effects, local recurrence, and general outcome. Methods: We reviewed charts of patients who were diagnosed with stage l-lll ASqCC. All participating patients received chemoradiation at the Assuta Medical Center between 2011 and 2019. Results: In this study, 43 patients with ASqCC were eligible; 14 received 5-FU and 29 were treated with capecitabine. Basic characteristics were similar between the two groups, with longer follow-up for the 5-FU group. Six months following treatment, 100% (13/13 with adequate follow-up) of the 5-FU group had complete clinical response, compared to 84% in the capecitabine group (21/24), P= 0.143. The local recurrence incidence was higher in the 5-FU group at 23% (7,10,26 months following therapy, and none in the capecitabine group (P = 0.088). Although local and hematological toxicities were similar between groups, one patient receiving capecitabine died during chemoradiotherapy. Conclusions: Oral capecitabine demonstrated non-inferior disease control in ASqCC treated with chemoradiotherapy. We recommend oral capecitabine over continuous IV 5-FU in locally and locally advanced ASqCC. Close monitoring of side effects is required to reduce major toxicity.

Original languageEnglish
Pages (from-to)126-130
Number of pages5
JournalIsrael Medical Association Journal
Issue number2
StatePublished - Feb 2023
Externally publishedYes


  • 5-fluorouracil (5-FU)
  • anal squamous cell carcinoma (ASqCC)
  • capecitabine
  • chemoradiation
  • dihydropyrimidine dehydrogenase (DPD)


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