Abstract
Background: Over the past few years our knowledge of the aetiology and epidemiology of anal cancer has moved forward dramatically. Primary treatment has changed from surgery to radiotherapy and combined modality therapy.
Methods: The surgical management of anal cancer at St. Mark’s hospital from 1948 to 1984 is analysed.
Results: 72 patients were treated for anal margin cancer, mostly by local excision and in some instances by radiotherapy. The 5-year survival rate was 57%. Out of 145 patients with anal canal cancer the majority underwent total rectal excision. The 5-year survival rate of 123 patients, eligible for long term assessment, was 58%.
Conclusions: The emerging evidence that surgery should be abandoned in most cases in favour of a primarily non-surgical approach has stimulated a multicentre randomised trial in the United Kingdom comparing a combined regimen with radiotherapy alone. The trial is coordinated by a St. Mark’s surgeon and its main thrust must be to define the most effective non-surgical regimens optimising local control while minimising side effects of treatment. Surgery has still an important role when primary therapy fails, either initially or subsequently.
Zusammenfassung
Hintergrund: Unsere Kenntnisse über Ätiologie und Epidemiologie des Analkarzinoms haben während der wenigen vergangenen Jahre dramatische Fortschritte gemacht.
Methodik: Analysiert wird das chirurgische Management des Analkarzinoms im St. Mark’s Hospital von 1948 bis 1984.
Ergebnisse: 72 Patienten wurden wegen eines Analrandkarzinoms behandelt, zumeist mit Lokalexzision und in manchen Fällen mit Strahlentherapie. Die 5-Jahres-Überlebensrate betrug 57%. Der Großteil von 145 Patienten mit Analkanalkarzinom wurde einer Rektumexstirpation unterzogen. Die 5-Jahres-Überlebensrate von 123 zur Auswertung verfügbaren Patienten war 58%.
Schlußfolgerungen: Die zunehmenden Hinweise, daß die Chirurgie in den meisten Fällen zugunsten eines primär nichtchirurgischen Vorgehens aufgegeben werden sollte, führten in Großbritannien zu einer multizentrischen, randomisierten Studie, die eine kombinierte Therapieform mit alleiniger Strahlentherapie vergleichen soll. Die Studie wird von einem Chirurgen aus dem St. Mark’s Hospital koordiniert. Ihr Hauptziel ist es, die wirkungsvollste nichtchirurgische Therapieform zu definieren, die die lokale Tumorkontrolle bei gleichzeitig geringsten Nebenwirkungen optimiert. Die Chirurgie hat noch immer eine wesentliche Rolle, wenn die primäre Therapie versagt, sei es schon anfänglich oder im späteren Verlauf.
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Northover, J.M.A. Management of anal cancer — Past and present policy at St. Mark’s hospital. Acta Chir Austriaca 26, 361–365 (1994). https://doi.org/10.1007/BF02620036
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DOI: https://doi.org/10.1007/BF02620036