Efficacy of radiation therapy alone for limited squamous cell carcinoma of the anal canal.

From 1973-1986, thirty-five patients with limited squamous cell carcinoma of the anal canal underwent definitive radiation therapy only. There were twenty females and fifteen males with average ages of 65 and 53 years, respectively. Twelve of the fifteen males were admittedly homosexual. The primary lesions were less than 5 cm in maximum dimension and were confined to the anal canal. Two patients presented with regional adenopathy. Chemotherapy was not used in any case. Treatment plans were individualized but usually included whole pelvis and boost external beam irradiation. The average tumor dose was 6395 cGy (range 4525-7550 cGy). One interstitial Ir-192 implant was performed. Local control was 77% (27/35) following radiation therapy alone. Seven of the eight failures were salvaged surgically, five by abdominoperineal resection and two by local excision, for an overall rate of 97% (34/35). The 5-year actuarial disease-free survival is 92%. Only two patients have disseminated and/or died of neoplasm. Anal continence was retained in 80% (28/35). Early and late complication rates were acceptable.

Primary radiation therapy in the treatment of anal carcinoma.

From 1966 to 1981, 47 patients with a diagnosis of anal carcinoma were irradiated. This group was composed of 23 males and 24 females, with age ranging from 38-84 years (average 64.4 years). The average age of the males was eight years less than the females. Of the 47 patients, 39 had an intact anal canal following biopsy and were treated with curative intent. Thirty-one of these 39 had no evidence of nodal metastasis (N0) and eight had groin, pelvic and/or para-aortic nodal disease. Only three patients were treated with pre-irradiation chemotherapy; all had locally advanced disease. Five patients were treated preoperatively and 34 were treated definitively with cancericidal doses of irradiation. Acute radiation reactions requiring a rest-break were noted in 28% of patients, but all were managed as outpatients without untoward chronic sequelae. Chronic complications were noted in 13 patients, including two patients who required colostomy for severe anal stenosis and two who required A-P resection for large painful ulcers. Two of these four patients had received part of their treatment with an interstitial implant and one had an excessively high dose of perineal irradiation. Twenty-eight of 35 patients (80%) treated with irradiation alone have remained locally controlled without further treatment. An additional four have been salvaged by surgery. Only three patients had interstitial implants as part of their treatment course. Actuarial survival at five years for the N0 patients and the group as a whole are 95.6 and 79.3%, respectively. It is concluded that external beam irradiation alone, properly fractionated to cancericidal doses, can control anal carcinoma with acceptable morbidity rates and without the use of either chemotherapy or interstitial implants in most cases. There is also a strong correlation suggesting that anal intercourse and male homosexuality play a significant role in the etiology of this disease.

Carcinoma of the esophagus: an analysis of results and of treatment techniques.

Results of radiation therapy in 85 patients with squamous cell carcinoma of the esophagus are presented. Whereas the majority of patients with this tumor have been shown to die within the first year, occasional patients may survive longer (21.5 percent in this series); late radiation complications must therefore be maintained at a minimum. A localization technique to evaluate esophageal mobility away from the spinal cord is described.