Conservative Chemoradiation Treatment for Epidermoid Carcinoma of the Anal Canal

ABSTRACT

PURPOSE: Anal canal carcinoma is a rare clinical entity accounting for 1 to 3 percent of all gastrointestinal malignancies. Prevoiously, abdominoperineal resection was the primary modality of treatment. However, a recurrence rate of 20 to 40 percent has been observed following this procedure. In recent years, multimodal therapy with radiation and chemotherapy has been shown to at least equal the results obtained through surgery with the ability to preserve sphincter function. The objective of this study is to evaluate the survival, recurrence pattern, acute and late morbidity rates of a widely used combined chemotherapy and radiation therapy regimen given to patients with carcinoma of the anal canal. METHODS: Ten patients received radiation therapy (5,000~5,400 cGy) and chemotherapy (mitomycin-C plus 5-fluorouracil) as a primary treatment between 1988 and 1998. RESULTS: Patients with primary tumors had a complete response rate of 60 percent and a 10-year corrected survival rate and disease-free survival rate of 77.14 percent and 60 percent, respectively. There was a significant difference in survival rates and disease-free survival rates according to AJCC stage. Acute complications (grade III~IV, ECOG toxicity criteria) such as leukopenia, anemia, thrombocytopenia and radiation dermatitis were seen in 10 to 50 percent of cases. Furthermore, 20 percent of patients experienced late treatment-related symptoms including perineal fibrosis and incontinence due to sphincter dysfunction. CONCLUSION: The current treatment regimen is effective but carries a considerable risk of complications. Therefore, new chemotherapeutic modalities that may reduce such complications, but still potent, are needed.