Salvage abdominoperineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus
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Background: Up to one-third of patients with anal epidermoid cancer will fail initial chemoradiotherapy (CT-RT) or have local recurrence after treatment. This study evaluates the Memorial Sloan-Kettering Cancer Center (MSKCC) experience with salvage abdominoperineal resection (APR) in these patients.
Methods: Thirty-eight patients who underwent salvage APR following 5-fluorouracil (5-FU), mitomycin C, and radiotherapy over the past 12 years were analyzed by retrospective review. Survival was calculated by the Kaplan-Meier method and comparisons by log-rank analysis.
Results: The indications for APR were recurrent disease after CT-RT in 14 patients and persistent disease in 24 patients. Median follow-up time and survival were 47 and 41 months, respectively. The actuarial 5-year survival was 44%. Twenty-three patients had recurrent disease after APR. Inguinal lymphadenopathy at initial presentation (p<0.05), fixation of tumor to the pelvic sidewall (p<0.01), and pathologic involvement of the perirectal fat (p<0.01) adversely affected survival. Age, gender, initial response to CT-RT, initial stage of the primary tumor, histologic levator muscle involvement, status of perirectal lymph nodes, and extent of lymphadenectomy did not affect survival.
Conclusions: Salvage APR can be expected to yield a moderate number of long-term survivors, but the high rate of disseminated failure suggests the need for additional postoperative treatment.
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Annals of Surgical Oncology
Volume 1, Issue 2 , pp 105-110
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Anal cancer
- Abdominoperineal resection
- Treatment failure
- Industry Sectors
- Author Affiliations
- 1. From the Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
- 2. Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, 10021, New York, NY, USA