Treatment options for anal carcinoma

  • A. Infantino
  • L. Pisegna Cerone
  • C. H. Crane


Although anal cancer is a rare condition its incidence rate seems to have increased progressively. As described in a recent study carried out in Connecticut [1], the incidence rate is 1.9 in males and 2.3 in females and is lower in white males (0.41/100000) and higher in black females (0.74/100000). The increased incidence rate has also been confirmed by a study on three cancer registers in Great Britain where it is emphasized that situations at risks are unmarried status, homosexual behavior, immunodeficiency syndromes and immunosuppression [2].


Anal Canal Intensity Modulate Radiation Therapy Anal Cancer Endorectal Ultrasonography Anal Carcinoma 
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  1. 1.
    Melbye M, Rabkin C, Frisch M, Biggar RJ. Changing patterns of anal cancer incidence in the United States, 1940–1989. Am J Epidemiol 1994;139:772–780PubMedGoogle Scholar
  2. 2.
    Schoenfield JH, Jones HT, Cuzick J, Northover JMA. Anal cancer and marital status. Br J Cancer 1990;162:286–288CrossRefGoogle Scholar
  3. 3.
    Noffsinger AE, Hui YZ, Suzuk L, Yochman LK, Miller MA, Hurtubire P, Gal AA, Fenoglio-Preiser CM. The relationship of human papillomavirus to proliferation and ploidy in carcinoma of the anus. Cancer 1995;75:958–967PubMedCrossRefGoogle Scholar
  4. 4.
    Heino P, Eklund C, Fredriksson-Shanazarian V, Goldman S, Schiller JT, Dillner J. Association of serum immunoglobulin G antibodies against human papillomavirus type 16 capsids with anal epidermoid carcinoma. J Natl Cancer Inst 1995;87:437–440PubMedCrossRefGoogle Scholar
  5. 5.
    Frisch M, Olsen JH, Melbye M. Malignancies that occur before and after anal cancer: clues to their etiology. Am J Epidemiol 1994;140: 9–12Google Scholar
  6. 6.
    Nigro ND, Vaitnevicius VK, Considine B. Combined therapy for cancer of the anal cancer: a preliminary report. Dis Colon Rectum 1974;17:354–356PubMedCrossRefGoogle Scholar
  7. 7.
    Nigro ND, Seydel HE, Considine F, Vaitkevicius VK, Leichman L, Kinzie JJ. Combined preoperative radiation and chemotherapy for squamous cell carcinoma of the anal canal. Cancer 1983;51:1826–1829PubMedCrossRefGoogle Scholar
  8. 8.
    Flam MS, John M, Lovalvo LJ, Mills RJ, Ramalho LD, Prather C, Mowry PA, Morgan DR, Lau BP. Definitive non surgical therapy of epithelial malignancies of the anal canal: a report of 12 cases. Cancer 1983;51: 1378–1387PubMedCrossRefGoogle Scholar
  9. 9.
    Meeker WR Jr, Sickle-Santanello BJ, Philpott G, Kenady D, Bland KI, Hill GH, Popp MB. Combined chemotherapy, radiation and surgery for epithelial cancer of the anal canal. Cancer 1986;57:525–529PubMedCrossRefGoogle Scholar
  10. 10.
    Byfield JE. Theoretical basis and clinical applications of 5FU as a radiosensiter — an overview. In: Rotman M and Rosenthal CJ. Concomitant continuous infusion chemotherapy and radiation, Springer Verlag, Berlin 199;115–127Google Scholar
  11. 11.
    Staib L, Gottwald T, Lehnert T, Ruf G, Sturm J, Becker HD, Farthmonn E, Herparth C, Post S, Trede M, Berger HG. Sphincter-saving treatment in epidermoid anal cancer: cooperative analysis of 142 patients in five German university surgical centers. Int J Colorect Dis 2000;15:282–290CrossRefGoogle Scholar
  12. 12.
    Martenson JA jr, Gunderson LL. External ratiation therapy without chemotherapy in the management of anal cancer. Cancer 1993;71:1736–1740PubMedCrossRefGoogle Scholar
  13. 13.
    Pignon T, Horiot JC, Bolla M, van Poppel H, Bartelink H, Roelofsen F, Pene F, Gerard A, Einhorn N, Nguyen TD, Vanglabbeke M, Scalliet P. Age is not a limiting factor for radical radiotherapy in pelvic malignancies. Radiother Oncol 1997;42:107–120PubMedCrossRefGoogle Scholar
  14. 14.
    Wagner JP, Mahe MA, Romestaing P, Rocher FP, Berger C, Trillet-Lencir V, Gerard JP. Radiation therapy in the conservative treatment of carcinoma of the anal canal. Int J Radiat Oncology Biol Phys 1994;29:17–23CrossRefGoogle Scholar
  15. 15.
    Brunet R, Becouarn V, Pigneux J, et al. Cisplatine (P) et Fluorouracile (FU) en chemiotherapie neoadjuvante des carcinomes epidermoides du canal anal. Lyon Chir 1991;87:77–78Google Scholar
  16. 16.
    Belliere A, Chapet O, Coquard R, Romestaing P, Ardiet JM, Gerard JP. Brachytherapy in carcinomas of anal canal and rectum: techniques and results. Cancer Radiother 2003;7:24–32PubMedCrossRefGoogle Scholar
  17. 17.
    Nigro ND. Mutidisciplinary management of cancer of the anus. World J Surg 1987;11:446–451PubMedCrossRefGoogle Scholar
  18. 18.
    Cummings BJ. Concomitant radiotherapy and chemotherapy for anal cancer. Semin Oncol 1992;19:102–108PubMedGoogle Scholar
  19. 19.
    Pfeiffert D, Bey P, Pernot M, Guillemin F, Luporsi E, Hoffstetter S, Aletti P, Boissel P, Bigard MA, Dartois D, Baylac F. Conservative treatment by irradiation of epidermoid cancers of the anal canal: prognostic factors of tumoral control and complications. Int J Radiat Oncol Biol Phys 1997;37:313–324CrossRefGoogle Scholar
  20. 20.
    Roelofsen F, Bosset JF, Eschwege F. Concomitant radiation and chemotherapy superior to radiotherapy alone in the treatment of locally advanced anal cancer. Results of phase III randomized trial of the EORTC radiotherapy and Gastrointestinal Cooperative Group Proc ASCO 14, 1995Google Scholar
  21. 21.
    Bartelink H, Roelofsen F, Eschwege F, Rougier P, Bosset JF, Gonzalez DG, Peiffert D, van Glabbeke M, Pierart M. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 1997;15:2040–2049PubMedGoogle Scholar
  22. 22.
    UKCCCR Anal Cancer Trial Working Party. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin C. Lancet 1996;348:1049–1054CrossRefGoogle Scholar
  23. 23.
    Flam MS, John M, Pajak TF, et al. Radiation (RT) and 5-Fluorouracil (5FU) vs. Radiation, 5FU, Mitomycin-C (MMC) in the treatment of anal carcinoma: results of a Phase III randomized RTOG/ECOG intergroup trial. Anticancer Research 1995;15:1740Google Scholar
  24. 24.
    Flam MS, John M, Pajak TF, Petrelli N, Myerson R, Doggett S, Quivey J, Rotman M, Kerman H, Coia L, Murray K. Role of Mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive non surgical treatment of epidermoidal carcinoma of the anal canal: results of phase III randomized intergroup study. J Clin Oncol 1996;14:2527–2539PubMedGoogle Scholar
  25. 25.
    Cummings BJ, Keane TJ, O’Sullivan B, Wong CS, Catton CN. Mitomicyn in anal canal carcinoma. Oncology 1993;50:S63–S69CrossRefGoogle Scholar
  26. 26.
    John MJ, Flam M, Lovalvo L, Mowry PA. Feasibility of non surgical definitive management of anal canal carcinoma. Int J Radiat Oncol Biol Phys 1987;13:299–303PubMedCrossRefGoogle Scholar
  27. 27.
    Valentini V, Mantello G, Luzi S, Genovesi D, Smaniotto D, Mantini G, Coco C, Ratto C, Sofo L, Cellini N. The anal canal cancer: 2 cycles of radiochemotherapy and boost brachytherapy. Radiol Med 1997;93:451–456PubMedGoogle Scholar
  28. 28.
    Cummings BJ. Anal canal cancer: To split or not to split. Cancer J Sci Am 1996;2:194–196PubMedGoogle Scholar
  29. 29.
    Allai AS, Mermillod B, Roth AD, Marti MC, Kurtz JM. The impact of treatments factors on local control in T2–T3 anal carcinomas treated by radiotherapy with or without chemotherapy. Cancer 1997;79:2329–2335CrossRefGoogle Scholar
  30. 30.
    Iwamoto T, Nakahara S, Mibu R, Hotokezaka M, Nakano H, Takana M. Effect of radiotherapy on anorectal function in patients with cervical cancer. Dis Colon Rectum 1997;40:693–697PubMedCrossRefGoogle Scholar
  31. 31.
    Doci R, Zucali R, La Monica G, Meroni E, Kenda R, Eboli M, Lozza L. Primary chemoradiation therapy with fluorouracil and cisplatin for cancer of the anus: results in 35 consecutive patients. J Clin Oncol 1996;14:3121–3125PubMedGoogle Scholar
  32. 32.
    Gerard JP, Ayzac L, Hun D, Romestaing P, Coquard R, Ardiet JM, Mornex R Treatment of anal canal carcinoma with high dose radiation therapy and concomitant fluorouracilcisplatinum. Long-term results in 95 patients. Radiother Oncol 1998;46:249–256PubMedCrossRefGoogle Scholar
  33. 33.
    Hung A, Crane C, Delclos M, Ballo M, Ajani J, Lin E, Feig B, Skibber J, Janjan N. Cisplatinum-based combined modality therapy for anal carcinoma: a wider therapeutic index. Cancer 2003;97:1195–1202PubMedCrossRefGoogle Scholar
  34. 34.
    Schneider HF, Grabenbauer GG, Reck T, Kockerling F, Sauer R, Gall FP. Combined radiation and chemotherapy for epidermoid carcinoma of the anal canal. Int J Colorect Dis 1992;7:192–196CrossRefGoogle Scholar
  35. 35.
    John M, Pajak T, Flam M, Hoffman J, Markoe A, Wolkov H, Paris K. Dose escalation in chemoradiation for anal cancer: preliminary results of RTOG 9208. Cancer J Sci Am 1996;2:205–211PubMedGoogle Scholar
  36. 36.
    Bosset JF, Roelofsen F, Morgan DA, Budach V, Coucke P, Jager JJ, Van der Steen-Banasik E, Triviere N, Stuben G, Puyraveau M, Mercier M. European Organization for Research and Treatment of Cancer. Radiotherapy and Gastrointestinal Cooperative Groups. Shortened irradiation scheme, continuous infusion of 5-fluorouracil and fractionation of mitomycin C in locally advanced anal carcinomas. Results of a phase II study of the European Organization for Research and Treatment of Cancer. Radiotherapy and Gastrointestinal Cooperative Groups. Eur J Cancer 2003;39:45–51PubMedCrossRefGoogle Scholar
  37. 37.
    Svensson C, Goldman S, Friberg B, Glimelius B. Induction chemotherapy and radiotherapy in locoregionally advanced epidermoid carcinoma of the anal canal. Int J Radiat Oncol Biol Phys 1998;41:863–867PubMedCrossRefGoogle Scholar
  38. 38.
    Lee DH, Kim I, Song HH, Jung JY, Kim DY, Lee KW, Kim TY, Heo DS, Bang YJ, Ha SW, Park JG, Kim NK. Induction chemotherapy followed by radiotherapy in the treatment of anal cancer. Oncol Rep 2003;10:101–104PubMedGoogle Scholar
  39. 39.
    Peiffert D, Giovannini M, Ducreux M, Michel P, Francois E, Lemanski C, Mirabel X, Cvitkovic F, Luporsi E, Conroy T, Gerard JP. Digestive Tumors Group of the French ‘Federation Nationale des Centres de Lutte Contre le Cancer’ High-dose radiation therapy and neoadjuvant plus concomitant chemotherapy with 5-fluorouracil and cisplatin in patients with locally advanced squamous-cell anal canal cancer: final results of a phase II study. Ann Oncol 2001;12:397–404PubMedCrossRefGoogle Scholar
  40. 40.
    Gerard JP, Chapet O, Samiei F, Morignat E, Isaac S, Paulin C, Romestaing P, Favrel V, Mornex F, Bobin JY. Management of inguinal lymph node metastases in patients with carcinoma of the anal canal: experience in a series of 270 patients treated in Lyon and review of the literature. Cancer 2001;92:77–84PubMedCrossRefGoogle Scholar
  41. 41.
    Peley G, Farkas E, Sinkovics I, Kovacs T, Keresztes S, Orosz Z, Koves I. Inguinal sentinel lymph node biopsy for staging anal cancer. Scand J Surg 2002;91:336–338PubMedGoogle Scholar
  42. 42.
    Smith AJ, Whelan P, Cummings BJ, Stern HS. Management of persistent or locally recurrent epidermoid cancer of the anal canal with abdominoperineal resection. Acta Oncol 2001;40:34–36PubMedCrossRefGoogle Scholar
  43. 43.
    Pocard M, Tiret E, Nugent K, Dehni N, Parc R. Results of abdominoperineal resection for anal cancer after Rt (54 Gy — no Ct). Dis Colon Rectum 1998;41:1488–1493PubMedCrossRefGoogle Scholar
  44. 44.
    Allai AS, Laurencet FM, Reymond MA, Kurtz JM, Marti MC. Effectiveness of surgical salvage therapy for patients with locally uncontrolled anal carcinoma after sphincter-conserving treatment. Cancer 1999; 86:405–409CrossRefGoogle Scholar
  45. 45.
    Nilsson PJ, Svensson C, Goldman S, Glimelius B. Salvage abdominoperineal resection in anal epidermoid cancer. Br J Surg 2002;89:1425–1429PubMedCrossRefGoogle Scholar
  46. 46.
    van der Wal BC, Cleffken BI, Gulec B, Kaufman HS, Choti MA. Results of salvage abdominoperineal resection for recurrent anal carcinoma following combined chemoradiation therapy. J Gastrointest Surg 2001;5:383–387PubMedCrossRefGoogle Scholar
  47. 47.
    Joseph VT, Wee JTK. New technique of vaginal reconstruction using neurovascular pudendal-thigh flaps. In Strauch B, Vasconez O, and Hall-Findlay EJ. Grabb’s Encyclopedia of Flaps, 2nd Ed. Philadelphia: Lippincott-Raven 1998,1466–1470Google Scholar
  48. 48.
    Pisegna Cerone L, Papadia A, Infantino A. Ricostruzione “tailor-made” del perineo con lembi pudendi interni dopo resezione neoplastica. Atti del Congresso SICP-UCP Bologna 2002Google Scholar
  49. 49.
    Minkoff H, Ahdieh L, Massad LS, Anastos K, Watts DH, Melnick S, Muderspach L, Burk R, Palefsky J. The effect of highly active antiretroviral therapy on cervical cytologic changes associated with oncogenic HPV among HIV-infected women. AIDS 2001;15:2157–2164PubMedCrossRefGoogle Scholar
  50. 50.
    Fox P, Stebbing J, Portsmouth S, Winston A, Frances N, Nelson M, Gazzard B, Bower M. Lack of response of anal intra-epithelial neoplasia to highly active antiretroviral therapy. AIDS 2003;17:279–280PubMedCrossRefGoogle Scholar
  51. 51.
    Palefsky JM, Holly EA, Ralston ML, Da Costa M, Bonner H, Jay N, Berry JM, Darragh TM. Effect of highly active antiretroviral therapy on the natural history of anal squamous intraepithelial lesions and anal human papillomavirus infection. J Acquir Immune Defic Syndr 2001;28:422–428PubMedGoogle Scholar
  52. 52.
    Goldstone SE, Palefsky JM, Winnett MT, Neefe JR. Activity of HpsE7, a novel immunotherapy, in patients with anogenital warts. Dis Colon Rectum 2002;45:502–507PubMedCrossRefGoogle Scholar
  53. 1.
    Nigro ND, Seydel HE, Considine F, et al. Combined preoperative radiation and chemotherapy for squamous cell carcinoma of the anal canal. Cancer 1983; 51:1826–1829PubMedCrossRefGoogle Scholar
  54. 2.
    Hung A, Crane C, Delclos M, et al. Cisplatin-based combined modality therapy for anal carcinoma: a wider therapeutic index. Cancer 2003;97:1195–1202PubMedCrossRefGoogle Scholar
  55. 3.
    Vuong T, Devic S, Belliveau P, et al. Contribution of conformai therapy in the treatment of anal canal carcinoma with combined chemotherapy and radiotherapy: results of a phase II study. Int J Radiat Oncol Biol Phys 2003;56:823–831PubMedCrossRefGoogle Scholar
  56. 4.
    Papagikos M, Crane CH, Skibber J, et al. Chemoradiation for adenocarcinoma of the anus. Int J Radiat Oncol Biol Phys 2003;55:669–678PubMedCrossRefGoogle Scholar
  57. 5.
    Ballo MT, Gershenwald JE, Zagars GK, et al. Sphincter-sparing local excision and adjuvant radiation for analrectal melanoma. J Clin Oncol 2002;20:4555–4558PubMedCrossRefGoogle Scholar

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© Springer-Verlag Italia 2004

Authors and Affiliations

  • A. Infantino
  • L. Pisegna Cerone
  • C. H. Crane

There are no affiliations available

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