During the past ten years, substantial progress has been made in the knowledge of the natural history of epidermoid carcinoma of the anal canal and of the response of the disease to radiotherapy alone or combined with chemotherapy. At the present time, the main problem in the management of this tumor concerns identification of the best modalities to achieve local control and preservation of anal function. From a series of 276 cases, followed for more than three years, the necessity for a careful pretreatment evaluation was stressed. This included a systematic search for pelvic metastatic lymph nodes by palpation and CT scan. All patients were treated initially by irradiation except those who underwent groin dissection for inguinal node metastasis or colostomy for complete anal obstruction. Three groups of patients have been identified: 1) unresectable or disseminated tumors (33 cases), 2) resectable tumors but not suitable for sphincter conservation (21 cases) treated by radiochemotherapy and delayed surgery, and 3) resectable tumors suitable for sphincter conservation (222 cases) which were treated by a split-course regimen combining a short course of carefully planned external beam irradiation (19 days) followed by an iridium 192 implant after a two-month rest. In this group, which represents 80 percent of the whole series, 80 percent of patients have had their cancer controlled and 90 percent of controlled patients have retained normal anal function. The use of chemotherapy during the first days of irradiation is advisable in all cases to reinforce the efficacy of treatment and increase the chance of anal preservation. Results of the split-course regimen, combining external beam and interstitial irradiation, demonstrate a clear superiority over external beam irradiation alone, especially for large infiltrating tumors, which represent the majority of cases.
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Nigro ND, Vaitkevicius VK, Considine B Jr. Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum 1974;17:354–6.
Quan SH, Magill GB, Leaming RH, Hajdu SI. Multidisciplinary preoperative approach to the management of epidermoid carcinoma of the anus and anorectum. Dis Colon Rectum 1978; 21:89–91.
Wanebo JH, Constable WC, Futrell JW, Rosenoff S. A multimodality approach to the surgical management of locally advanced epidermoid carcinoma of the anorectum (abstr). Proc Am Assoc Cancer Res 1980;21:417.
Buroker TR, Nigro N, Bradley G, et al. Combined therapy for cancer of the anal canal: a follow-up report. Dis Colon Rectum 1977;20:677–8.
Cummings BJ, Harwood AR, Keane TJ, Thomas GM, Rider WD. Combined treatment of squamous cell carcinoma of the anal canal: radical mitomycin-C, a preliminary report. Dis Colon Rectum 1980; 23:389–91.
Parks A. Squamous carcinoma of the anal canal. Ann Gastroenterol Hepatol 1981;17:103–7.
Loygue J, Laugier A, Parc R, Weisgerber G. Carcinome épidermoide de l'anus, à propos de 149 observations. Chirurgie 1980;109:710–6.
Boman BM, Moertel CG, O'Connell MJ, et al. Carcinoma of the anal canal: a clinical and pathologic study of 188 cases. Cancer 1984;54:114–25.
Papillon J. Rectal and anal cancers. Conservative treatment by irradiation: an alternative to radical surgery. New York: Springer-Verlag, 1982.
Papillon J, Mayer M, Montbarbon JF, Gerard JP, Chassard JL, Bailly C. A new approach to the management of epidermoid carcinoma of the anal canal. Cancer 1983;51:1830–7.
Salmon RJ, Fenton J, Asselain B, et al. Treatment of epidermoid anal canal cancer. Am J Surg 1984;147:43–8.
Eschwege F, Lasser P, Chavy A, et al. Squamous-cell carcinoma of the anal canal: treatment by external beam irradiation. Radiother Oncol 1985;3:145–50.
Chruscov MM, Semakina EP, Raifel BA. Die Strahlentherapie des rektalen Epidermoidkarzinomas. Radiobiol Radiother (Berlin) 1978;19:683–9.
Rousseau J, Mathieu G, Fenton J. Resultats et complications de la radiothérapie des épithéliomas du canal anal. Etude de 128 cas traités de 1956 à 1970. Gastroenterol Clin Biol 1979;3:207–8.
Nigro ND. An evaluation of combined therapy for squamous cell cancer of the anal canal. Dis Colon Rectum 1984;27:763–6.
Cummings B, Keane T, Thomas G, Harwood A, Rider W. Results and toxicity of the treatment of anal canal carcinoma by radiation therapy or radiation therapy and chemotherapy. Cancer 1984;54:2062–8.
Stearns MW Jr, Quan SH. Epidermoid carcinoma of the anorectum. Surg Gyncol Obstet 1970;131:953–7.
Wolfe HR. The management of metastatic inguinal adenitis in epidermoid cancer of the anus. Proc R Soc Med 1968;61:626–8.
Beahrs OH. Management of cancer of the anus. AJR 1979;133: 791–5.
Goligher JC. Surgery of the anus, rectum, and colon. 3rd ed. London: Baillière Tindall, 1975.
Grinnell RS. An analysis of forty-nine cases of squamous cell carcinoma of the anus. Surg Gynecol Obstet 1954;98:29–39.
Judd ES Jr, De Tar BE Jr. Squamous-cell carcinoma of the anus results of treatment. Surgery 1955;37:220–8.
Bond WH. Discussion on squamous cell carcinoma of the anus and anal canal. Proc R Soc Med 1960;53:411–4.
Frost DB, Richards PC, Montague ED, Giacco GG, Martin RG. Epidermoid cancer of the anorectum. Cancer 1984;53:1285–93.
Hightower BM, Judd ES: Squamous-cell carcinoma of the anal canal and anus: current status of therapy. Mayo Clin Proc 1967;42:271–5.
Greenall MJ, Quan SH, DeCosse JJ. Epidermoid cancer of the anus. Br J Surg 1985;72:S97-S103.
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Papillon, J., Montbarbon, J.F. Epidermoid carcinoma of the anal canal. Dis Colon Rectum 30, 324–333 (1987). https://doi.org/10.1007/BF02555448
- Anal canal carcinoma
- External beam irradiation
- Iridium 192 implant
- Groin dissection