In Reply: Drs Musio and Codacci-Pisanelli suggest that the delay in initiating chemoradiation in the cisplatin-based treatment arm of our trial may be the reason for the adverse outcome compared with the mitomycin-based treatment arm. The study by Forastiere et al1 did conclude that concurrent chemoradiation was superior to radiotherapy alone or the sequence of induction chemotherapy followed by radiotherapy in patients with head and neck cancer. We do not draw a parallel between that study and ours because of completely different designs and hypotheses. However, in the study by Forastiere et al, the use of induction chemotherapy did provide a slight advantage over radiation alone for local control, but it was statistically nonsignificant. It could be that an investigation of induction chemotherapy followed by chemoradiation compared with chemoradiation in patients with head and neck cancer would provide some advantage. That strategy did not work in the patients with anal canal cancer in our study.
Ajani JA, Winter KA, Gunderson LL. Chemotherapy and Radiotherapy for Anal Canal Carcinoma—Reply. JAMA. 2008;300(12):1410-1411. doi:10.1001/jama.300.12.1411-a