Summary
For many years the accepted treatment for squamous cell cancer of the anal canal has been abdominoperineal resection of the rectum. Recently, high dose radiation therapy has been advocated by some, and we initiated a study using a combination of radiation, chemotherapy and surgery. This review includes 44 patients treated by us from December 1971 to July 1983. We discontinued routine operation after 1975 because chemoradiation therapy eliminated the primary lesion in most patients. In fact, the gross lesion disappeared in 40 patients, 13 of whom had radical operations done on routine basis. Four operations were done for residual disease after chemoradiation treatment and one for local recurrence. The corrected, projected five year survival rate was 79% with a follow-up of at least four years in all patients. Most failures occurred in patients with large primary tumors, all of whom had radical operations after the preoperative therapy. This experience suggests that patients with primary lesions over 5 cm in maximum diameter should have an additional course of chemoradiation and/or abdominoperineal resection on a routine basis.
Similar content being viewed by others
References
Morson BC, Pang LCS: Pathology of anal cancer. Proc R Soc Med 61:623–624, 1968
Schrant W, Wang C, Dawson P, Black G: Depth of invasion, location and size of cancer of the anus. Cancer 51: 1291–1296, 1983
Frost D, Richards P, Montague E, Giaceo G, Martin R: Epidermoid cancer of the anorectum. Cancer 53:1285–1293, 1984
Boman BM, Moertel CG, O'Connell MJ, Scott M, Weiland LH, Beart RW, Gunderson L, Spencer RJ: Carcinoma of the anal canal. Cancer 54:114–125, 1984
Nigro ND, Vaitkevicius VK, Considine Jr B: Combined therapy for cancer of the anal canal. Dis Colon Rectum 17: 354–356, 1974
Papillon J, Mayer M, Montbarbon J, Gerald J, Chassard J, Bailly C: A new approach to the management of epidermoid carcinoma of the anal canal. Cancer 51:1830–1837, 1983
Newman H, Quan S: Multimodality therapy for epidermoid carcinoma of the anus. Cancer 37:12–19, 1976
Meeker W, Sickle-Santonello B, Philpott G, Kenady D, Bland K, Hill G, Popp M: Combined chemotherapy, radiation, and surgery for epithelial cancer of the anal canal. Cancer 57:525–529, 1986
Buroker T, Nigro N, Considine B, Vaitkevicius V: Mitomycin C, 5-fluorouracil, and radiation therapy in squamous cell carcinoma of the anal canal. In: Carter S, Crooke S (eds) Mitomycin C. Academic Press, Inc. New York, 1979, pp 183–188
Leichman L, Nigro ND, Vaitkevicius VK, Considine B, Buroker T, Bradley G, Seydel HG, Olchowski S, Cummings G, Leichman C, Baker L: Cancer of the anal canal: Model for preoperative adjuvant combined modality therapy. Am J Medicine 78: 211–215, 1985
Nigro ND: An evaluation of combined therapy for squamous cell cancer of the anal canal. Dis Colon Rectum 27: 763–766, 1984
Kaplan E, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481, 1958
Vietti T, Eggerding F, Valeriote F: Combined effect of x radiation and 5-fluorouracil on survival of transplanted leukemia cells. J Natl Cancer Inst 47:865–870, 1971
Cummings BJ, Keane T, Thomas G, Harwood A, Rider W: Results and toxicity of the treatment of anal carcinoma by radiation therapy or radiation therapy and chemotherapy. Cancer 54:2062–2068, 1984
Rifkind R: Differentiation inducers: Freeing cancer cells to mature. Adv in Oncol 2:3–6, 1986
Kingsworth A, Russell W, McCann P, Malt R: Effects of difluoromethylornithine and 5-fluorouracil on human adenocarcinoma cell line. Cancer Res 43:4035–4038, 1983
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nigro, N.D., Vaitkevicius, V.K. & Considine, B. Dynamic management of squamous cell cancer of the anal canal. Invest New Drugs 7, 83–89 (1989). https://doi.org/10.1007/BF00178194
Issue Date:
DOI: https://doi.org/10.1007/BF00178194