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The role of radiation therapy in the treatment of anal carcinoma: Techniques and current recommendations

Aktueller Stand der Strahlentherapie des Analkarzinoms

  • Themenschwerpunkt: „Analkarzinom“
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Abstract

Background: In view of the results of surgery for anal cancer the treatment of choice is radiation therapy with or without chemotherapy.

Methods: From 1987 until 1990 a total of 14 patients have undergone primarily conservative treatment at the University Clinic of Radiology in Graz. 10 patients were treated with a split-course technique of external beam and interstitial radiation over a period of 7 weeks. In 4 patients a similar radiation protocol, omitting the second implantation, was combined with 2 courses of 5-Fluorouracil (5-FU) and Mitomycin C (MMC).

Results: Permanent tumor control was achieved in 8/10 cases after radiotherapy only, with sphincter preservation in 7 patients. Combined chemo-radiotherapy yielded complete remission in 3/4 patients. All failures of therapy occurred in T3 tumors.

Conclusions: At present the best results in terms of tumor response and toxicity are achieved by 5-FU and MMC given synchronously with radiotherapy. Radiation is preferably applied according to a split-course protocol, as established by Papillon.

Zusammenfassung

Grundlagen: In Hinblick auf die Ergebnisse der Chirurgie des Analkarzinoms ist die Behandlung der Wahl die Bestrahlung mit oder ohne Chemotherapie.

Methodik: Von 1987 bis 1990 wurden an der Universitätsklinik für Radiologie in Graz insgesamt 14 Patienten einer primär konservativen Therapie unterzogen. 10 Patienten erhielten eine „Split-course-Behandlung“ mit externer Bestrahlung und interstitieller Therapie über eine Dauer von 7 Wochen. Bei 4 Patienten wurde ein ähnliches Bestrahlungsprotokoll, unter Verzicht auf die 2. Implantation, mit 2 Zyklen von 5-Fluorouracil (5-FU) und Mitomycin C (MMC) kombiniert.

Ergebnisse: In 8 von 10 Fällen wurde mit ausschließlicher Strahlentherapie eine dauerhafte Heilung erzielt, bei 7 Patienten mit Sphinktererhaltung. Die kombinierte Chemo-Radiotherapie erreichte eine vollständige Remission in 3 von 4 Patienten. Alle Therapieversager fielen in die Gruppe der T3-Tumoren.

Schlußfolgerungen: Bezüglich Ansprechrate der Tumoren und Toxizität werden gegenwärtig die besten Ergebnisse mit 5-FU und MMC, gleichzeitig mit Strahlentherapie gegeben, erzielt. Die Strahlentherapie folgt vorzugsweise einem Split-course-Protokoll, wie es vonPapillon erstellt worden ist.

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Authors and Affiliations

  1. Division of Radiotherapy, Department of Radiology, University Graz, Auenbruggerplatz 9, A-8036, Graz, Austria

    Karin S. Arian-Schad & D. S. Kapp

  2. Clinical Department of Radiation Oncology, Stanford University School of Medicine, USA

    Karin S. Arian-Schad & D. S. Kapp

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  1. Karin S. Arian-Schad
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Arian-Schad, K.S., Kapp, D.S. The role of radiation therapy in the treatment of anal carcinoma: Techniques and current recommendations. Acta Chir Austriaca 26, 379–387 (1994). https://doi.org/10.1007/BF02620041

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