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Management of Anal Canal Cancer

  • Current Status
  • Published:
Diseases of the Colon & Rectum

PURPOSE

Chemoradiotherapy has replaced radical surgery as the initial treatment of choice for anal canal cancer. The roles of these therapeutic modalities are discussed and recommendations on management of anal canal cancer are made based on currently available evidence. Areas for further studies also are identified.

METHODS

Literature on management of anal canal cancer from January 1970 to July 2003 obtained via MEDLINE was reviewed. Reports on anal margin cancers were excluded.

RESULTS

Randomized, prospective, Phase 3 trials in Europe and the United States showed that chemoradiotherapy with 5-fluorouracil and mitomycin C was superior in local control, colostomy-free rate, progression-free survival, and cancer-specific survival compared with radiation alone. In larger tumors, the addition of mitomycin C to radiotherapy and 5-fluorouracil improves local control, colostomy-free, and disease-free survival but is associated with more acute hematologic toxicity. Chemoradiotherapy, including Cisplatin and 5-fluorouracil, appeared to be equal or superior to surgery as salvage therapy in patients with residual disease six weeks after initial nonsurgical treatment.

CONCLUSIONS

To improve treatment outcomes and reduce treatment-related toxicities, further studies are required to elucidate the optimal drug combination and doses, optimal radiation field, total dose, and fraction sizes. Randomized, multicenter trials are needed to define the treatment protocol that provides the highest rate of sphincter preservation with acceptable toxicity. Few studies addressed the treatment of metastatic disease, which remains a major cause of mortality.

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REFERENCES

  1. HR Wolfe HJ Bussey (1968) ArticleTitleSquamous-cell carcinoma of the anus Br J Surg 55 295–301 Occurrence Handle1:STN:280:DyaF1c7ptlCrtA%3D%3D Occurrence Handle5644395

    CAS  PubMed  Google Scholar 

  2. GT Golden JS Horseley (1976) ArticleTitleSurgical management of epidermoid carcinoma of the anus Am J Surg 131 275–80 Occurrence Handle10.1016/0002-9610(76)90115-X Occurrence Handle1:STN:280:DyaE287lvVGhuw%3D%3D Occurrence Handle1259098

    Article  CAS  PubMed  Google Scholar 

  3. JV Klas DA Rothenberger WD Wong RD Madoff (1999) ArticleTitleMalignant tumors of the anal canal: the spectrum of disease, treatment, and outcomes Cancer 85 1686–93 Occurrence Handle10.1002/(SICI)1097-0142(19990415)85:8<1686::AID-CNCR7>3.0.CO;2-7 Occurrence Handle1:STN:280:DyaK1M3jvVSksA%3D%3D Occurrence Handle10223561

    Article  CAS  PubMed  Google Scholar 

  4. DP Ryan CC Compton RJ Mayer (2000) ArticleTitleCarcinoma of the anal canal N Engl J Med 342 792–800 Occurrence Handle10.1056/NEJM200003163421107 Occurrence Handle1:STN:280:DC%2BD3c7ms1GqtQ%3D%3D Occurrence Handle10717015

    Article  CAS  PubMed  Google Scholar 

  5. GC Oliver SB Labow (1994) ArticleTitleNeoplasms of the anus Surg Clin North Am 74 1475–90 Occurrence Handle1:STN:280:DyaK2M%2Fns1emsA%3D%3D Occurrence Handle7985077

    CAS  PubMed  Google Scholar 

  6. E Touboul M Schlienger L Buffat et al. (1994) ArticleTitleEpidermoid carcinoma of the anal canal. Results of curative-intent radiation therapy in a series of 270 patients Cancer 73 1569–79 Occurrence Handle1:STN:280:DyaK2c3gsl2hug%3D%3D Occurrence Handle8156483

    CAS  PubMed  Google Scholar 

  7. DB Frost PD Richards ED Montague GG Giacco RG Martin (1984) ArticleTitleEpidermoid cancer of the anorectum Cancer 53 1285–93 Occurrence Handle1:STN:280:DyaL2c7gs1eksg%3D%3D Occurrence Handle6692319

    CAS  PubMed  Google Scholar 

  8. R Wolber B Dupuis P Thiyagaratnam D Owen (1990) ArticleTitleAnal cloacogenic and squamous carcinoma comparative histologic analysis using in situ hybridization for human papillomavirus DNA Am J Surg Pathol 14 176–82 Occurrence Handle1:STN:280:DyaK3c7ksFeisQ%3D%3D Occurrence Handle2154141 Occurrence Handle10.1097/00000478-199002000-00009

    Article  CAS  PubMed  Google Scholar 

  9. JM Palefsky EA Holly J Gonzales J Berline DK Ahn JS Greenspan (1991) ArticleTitleDetection of human papillomavirus DNA in anal intraepithelial neoplasia and anal cancer Cancer Res 51 1014–9 Occurrence Handle1:STN:280:DyaK3M7gsFKrug%3D%3D Occurrence Handle1846314

    CAS  PubMed  Google Scholar 

  10. KR Shroyer JG Kim MM Manos CE Greer NW Pearlman WA Franklin (1992) ArticleTitlePapillomavirus found in anorectal squamous carcinoma, not in colon adenocarcinoma Arch Surg 127 741–4 Occurrence Handle1:STN:280:DyaK383otFCgtA%3D%3D Occurrence Handle1317698

    CAS  PubMed  Google Scholar 

  11. JG Palmer JH Scholefield PJ Coates et al. (1989) ArticleTitleAnal cancer and human papillomaviruses Dis Colon Rectum 32 1016–22 Occurrence Handle1:STN:280:DyaK3c%2FnsF2jsQ%3D%3D Occurrence Handle2556252

    CAS  PubMed  Google Scholar 

  12. CW Critchlow CM Suravicz KK Holmes et al. (1995) ArticleTitleProspective study of high grade anal squamous intraepithelial neoplasia in a cohort of homosexual men: influence of HIV infection, immunosuppression and human papillomavirus infection AIDS 9 1255–62 Occurrence Handle1:STN:280:DyaK287is1Wrsg%3D%3D Occurrence Handle8561979

    CAS  PubMed  Google Scholar 

  13. M Melbye TR Cote L Kessler M Gail RJ Biggar (1994) ArticleTitleHigh incidence of anal cancer among AIDS patients. The AIDS/Cancer Working Group Lancet 343 636–8 Occurrence Handle10.1016/S0140-6736(94)92636-0 Occurrence Handle1:STN:280:DyaK2c7lvVGhsw%3D%3D Occurrence Handle7906812

    Article  CAS  PubMed  Google Scholar 

  14. D Caussy JJ Goedert J Palefsky et al. (1990) ArticleTitleInteraction of human immunodeficiency and papilloma viruses: association with anal epithelial abnormality in homosexual men Int J Cancer 46 214–9 Occurrence Handle1:STN:280:DyaK3czks1Cnuw%3D%3D Occurrence Handle2166710

    CAS  PubMed  Google Scholar 

  15. N Nigro V Vaitkevicius S Considine (1974) ArticleTitleCombined therapy for cancer of the anal canal: a preliminary report Dis Colon Rectum 17 354–6 Occurrence Handle1:STN:280:DyaE2c7ntFelsA%3D%3D Occurrence Handle4830803

    CAS  PubMed  Google Scholar 

  16. RJ Myerson LH Karnell HR Menck (1997) ArticleTitleThe national cancer data base report on carcinoma of the anus Cancer 80 805–15 Occurrence Handle10.1002/(SICI)1097-0142(19970815)80:4<805::AID-CNCR20>3.0.CO;2-W Occurrence Handle1:STN:280:DyaK2svgslKitA%3D%3D Occurrence Handle9264365

    Article  CAS  PubMed  Google Scholar 

  17. Beart RW. Malignant tumours of the anus. In: Ian AD, Bouchier IA, Allan RN, Hodgson HJ, Keighley MR, eds. Gastroenterology. London: WB Saunders, 1993:944–50

  18. ND Nigro (1987) ArticleTitleMultidisciplinary management of cancer of the anus World J Surg 11 446–51 Occurrence Handle10.1007/BF01655808 Occurrence Handle1:STN:280:DyaL2szitFCgsA%3D%3D Occurrence Handle3630189

    Article  CAS  PubMed  Google Scholar 

  19. J Papillon (1974) ArticleTitleRadiation therapy in the management of epidermoid carcinoma of the anal region Dis Colon Rectum 17 181–7 Occurrence Handle1:STN:280:DyaE2c7jt1SgtQ%3D%3D Occurrence Handle4819268

    CAS  PubMed  Google Scholar 

  20. M Rotmann CS Lange (1991) ArticleTitleAnal cancer: radiation and concomitant continuous infusion chemotherapy Int J Radiat Oncol Biol Phys 21 1385–7 Occurrence Handle1938540

    PubMed  Google Scholar 

  21. B Sischy (1985) ArticleTitleThe use of radiation therapy combined with chemotherapy in the management of squamous cell carcinoma of the anus and marginally respectable adenocarcinoma of the rectum Int J Radiat Oncol Biol Phys 11 1587–93 Occurrence Handle1:STN:280:DyaL2M3ovVClsQ%3D%3D Occurrence Handle3928544

    CAS  PubMed  Google Scholar 

  22. W Dobrowsky E Dobrowsky (1988) ArticleTitleCombined modality treatment of anal carcinoma Recent Results Cancer Res 110 140–5 Occurrence Handle1:STN:280:DyaL1czgsVygtQ%3D%3D Occurrence Handle3406496

    CAS  PubMed  Google Scholar 

  23. BM Boman CG Moertel MJ O’Connell et al. (1984) ArticleTitleCarcinoma of the anal canal: a clinical and pathologic study of 188 cases Cancer 54 114–25 Occurrence Handle1:STN:280:DyaL2c3gsFanug%3D%3D Occurrence Handle6326995

    CAS  PubMed  Google Scholar 

  24. RG Klotz T Pamukgoglu DH Souiliard (1967) ArticleTitleTransitional cloacogenic carcinoma of the anal canal. Clinicopathologic study of three hundred seventy-three cases Cancer 20 1727–45 Occurrence Handle6058180

    PubMed  Google Scholar 

  25. MJ Greennall SH Quan C Urmacher JJ DeCosse (1985) ArticleTitleTreatment of epidermoid carcinoma of the anal canal Surg Gynecol Obstet 161 509–17 Occurrence Handle3934775

    PubMed  Google Scholar 

  26. WH Schraut C Wang PJ Dawson GE Block (1983) ArticleTitleDepth of invasion, location, and size of cancer of the anus dictate operative treatment Cancer 51 1291–6 Occurrence Handle1:STN:280:DyaL3s7ivVyrsw%3D%3D Occurrence Handle6825051

    CAS  PubMed  Google Scholar 

  27. TC Schneider WJ Schulte (1981) ArticleTitleManagement of carcinoma of anal canal Surgery 90 729–34 Occurrence Handle1:STN:280:DyaL38%2Fhslyrug%3D%3D Occurrence Handle7281011

    CAS  PubMed  Google Scholar 

  28. M Flam M John TF Pajak et al. (1996) ArticleTitleRole of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase 3 randomized intergroup study J Clin Oncol 14 2527–39 Occurrence Handle1:CAS:528:DyaK28XlvVGisr0%3D Occurrence Handle8823332

    CAS  PubMed  Google Scholar 

  29. BJ Cummings TJ Keane B O’Sullivan CS Wong CN Catton (1991) ArticleTitleEpidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C Int J Radiat Oncol Biol Phys 21 1115–25 Occurrence Handle1:STN:280:DyaK38%2FktFSquw%3D%3D Occurrence Handle1938508

    CAS  PubMed  Google Scholar 

  30. JD Hardcastle HJ Bussey (1968) ArticleTitleResult of surgical treatment of squamous cell carcinoma of the anal canal and anal margin seen at St. Mark’s Hospital Proc R Soc Med 61 629–30 Occurrence Handle1:STN:280:DyaF1czis1Gntw%3D%3D Occurrence Handle4173822

    CAS  PubMed  Google Scholar 

  31. R Singh F Nime A Mittelman (1981) ArticleTitleMalignant epithelial tumors of the anal canal Cancer 48 411–5 Occurrence Handle1:STN:280:DyaL3M3gvFyktg%3D%3D Occurrence Handle7237411

    CAS  PubMed  Google Scholar 

  32. B Magdeburg M Fried C Meyenberger (1999) ArticleTitleEndoscopic ultrasonography in the diagnosis, staging, and follow-up of anal carcinomas Endoscopy 31 359–64 Occurrence Handle10.1055/s-1999-35 Occurrence Handle1:STN:280:DyaK1MzmtVChtA%3D%3D Occurrence Handle10433044

    Article  CAS  PubMed  Google Scholar 

  33. G Roseau L Palazzo P Colardelle S Chaussade D Couturier JA Paolaggi (1994) ArticleTitleEndoscopic ultrasonography in the staging and follow-up of epidermoid carcinoma of the anal canal Gastrointest Endosc 40 447–50 Occurrence Handle1:STN:280:DyaK2M%2FhtFegsQ%3D%3D Occurrence Handle7926535

    CAS  PubMed  Google Scholar 

  34. RH Cohan PM Silverman WM Thompson RA Halvorsen ME Baker (1985) ArticleTitleComputed tomography of epithelial neoplasms of the anal canal AJR Am J Roentgenol 145 569–73 Occurrence Handle1:STN:280:DyaL2M3nsFymug%3D%3D Occurrence Handle3875261

    CAS  PubMed  Google Scholar 

  35. BJ Cummings (1987) ArticleTitleTreatment of the primary epidermoid carcinoma of the anal canal Int J Colorectal Dis 2 107–12 Occurrence Handle10.1007/BF01647702 Occurrence Handle1:STN:280:DyaL2szhtVSltw%3D%3D Occurrence Handle3114396

    Article  CAS  PubMed  Google Scholar 

  36. PH Gordon (1990) ArticleTitleCurrent status—perianal and anal canal neoplasms Dis Colon Rectum 33 799–808 Occurrence Handle1:STN:280:DyaK3czmtVOltQ%3D%3D Occurrence Handle2202568

    CAS  PubMed  Google Scholar 

  37. DS Wade L Herrera NB Castillo NJ Petrelli (1989) ArticleTitleMetastases to the lymph nodes in epidermoid carcinoma of the anal canal studied by a clearing technique Surg Gynaecol Obstet 169 238–42 Occurrence Handle1:STN:280:DyaL1MzmvFWlug%3D%3D

    CAS  Google Scholar 

  38. MP Pintor JM Northover RJ Nicholls (1989) ArticleTitleSquamous cell carcinoma of the anus at one hospital from 1948 to 1984 Br J Surg 76 806–10 Occurrence Handle1:STN:280:DyaL1Mzltlektg%3D%3D Occurrence Handle2765832

    CAS  PubMed  Google Scholar 

  39. J Papillon JF Montbarbon (1987) ArticleTitleEpidermoid carcinoma of the anal canal. A series of 276 cases Dis Colon Rectum 30 324–33 Occurrence Handle1:STN:280:DyaL2s7ovFCqsQ%3D%3D Occurrence Handle3568920

    CAS  PubMed  Google Scholar 

  40. MR Keshtgar A Amin I Taylor PJ Ell (2001) ArticleTitleThe sentinel node in anal cancer Eur J Surg Oncol 27 113–4 Occurrence Handle10.1053/ejso.2000.1019 Occurrence Handle1:STN:280:DC%2BD3M7osFWmtA%3D%3D Occurrence Handle11237501

    Article  CAS  PubMed  Google Scholar 

  41. P Rabbitt N Pathman-Nathan T Collinson P Hewett N Rieger (2002) ArticleTitleSentinel lymph node biopsy for squamous cell carcinoma of the anal canal ANZ J Surg 72 651–4 Occurrence Handle10.1046/j.1445-2197.2002.02495.x Occurrence Handle12269917

    Article  PubMed  Google Scholar 

  42. D Perera N Pathman-Nathan P Rabbitt P Hewett N Rieger (2003) ArticleTitleSentinel node biopsy for squamous cell carcinoma of the anus and anal margin Dis Colon Rectum 46 1027–31 Occurrence Handle10.1007/s10350-004-7276-8 Occurrence Handle1:STN:280:DC%2BD3sznt1CltA%3D%3D Occurrence Handle12907894

    Article  CAS  PubMed  Google Scholar 

  43. DC Damin MA Rosito P Gus et al. (2003) ArticleTitleSentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal: early experience Dis Colon Rectum 46 1032–7 Occurrence Handle10.1007/s10350-004-7277-7 Occurrence Handle12907896

    Article  PubMed  Google Scholar 

  44. M Mistrangelo A Mobiglia B Mussa et al. (2002) ArticleTitleThe sentinel node in anal canal carcinoma Tumori 88 S51–2 Occurrence Handle1:STN:280:DC%2BD38nht1SjsA%3D%3D Occurrence Handle12369553

    CAS  PubMed  Google Scholar 

  45. PG Kuehn R Beckett H Eisenberg J Reed (1964) ArticleTitleEpidermoid carcinoma of the perianal skin and anal canal N Engl J Med 270 614–7 Occurrence Handle1:STN:280:DyaF2c%2FlsVGlsw%3D%3D Occurrence Handle14096882 Occurrence Handle10.1056/NEJM196403192701205

    Article  CAS  PubMed  Google Scholar 

  46. MV Madden MS Elliot JBC Botha JH Louw (1981) ArticleTitleThe management of anal carcinoma Br J Surg 68 287–9 Occurrence Handle1:STN:280:DyaL3M7osFamtQ%3D%3D Occurrence Handle7225745

    CAS  PubMed  Google Scholar 

  47. MW Stearns SH Quan (1970) ArticleTitleEpidermoid carcinoma of the anorectum Surg Gynecol Obstet 131 953–7 Occurrence Handle5471546

    PubMed  Google Scholar 

  48. JP Welch RA Malt (1977) ArticleTitleAppraisal of the treatment of carcinoma of the anus and anal canal Surg Gynecol Obstet 145 837–41 Occurrence Handle1:STN:280:DyaE1c%2FlsFSmtw%3D%3D Occurrence Handle929354

    CAS  PubMed  Google Scholar 

  49. J Clark N Petrelli L Herrera A Mittelman (1986) ArticleTitleEpidermoid carcinoma of the anal canal Cancer 57 400–6 Occurrence Handle1:STN:280:DyaL287gsFKhsQ%3D%3D Occurrence Handle3942974

    CAS  PubMed  Google Scholar 

  50. OH Beahrs SM Wilson (1976) ArticleTitleCarcinoma of the anus Ann Surg 184 422–8 Occurrence Handle1:STN:280:DyaE2s7htVyltA%3D%3D Occurrence Handle189707

    CAS  PubMed  Google Scholar 

  51. PH O’Brien JM Jenrette KM Wallace JS Metcalf (1982) ArticleTitleEpidermoid carcinoma of the anus Surg Gynecol Obstet 155 745–51 Occurrence Handle1:STN:280:BiyD2c7ntlQ%3D Occurrence Handle7135187

    CAS  PubMed  Google Scholar 

  52. PC Pyper TG Parks (1985) ArticleTitleThe results of surgery for epidermoid carcinoma of the anus Br J Surg 72 712–4 Occurrence Handle1:STN:280:DyaL28%2FgtFamsA%3D%3D Occurrence Handle4041732

    CAS  PubMed  Google Scholar 

  53. JL Sawyers (1977) ArticleTitleCurrent management of carcinoma of the anus and perianus Am Surg 43 424–9 Occurrence Handle1:STN:280:DyaE2s3hvF2quw%3D%3D Occurrence Handle195503

    CAS  PubMed  Google Scholar 

  54. MW Stearns C Urmacher SS Sternberg J Woodruff F Attiyeh (1980) ArticleTitleCancer of the anal canal Curr Probl Cancer 4 1–44 Occurrence Handle7408530

    PubMed  Google Scholar 

  55. SH Quan (1978) ArticleTitleAnal and perianal tumors Surg Clin North Am 58 549–603

    Google Scholar 

  56. RJ Salmon J Fenton B Asselain et al. (1984) ArticleTitleTreatment of epidermoid anal canal cancer Am J Surg 147 43–8 Occurrence Handle10.1016/0002-9610(84)90032-1 Occurrence Handle1:STN:280:DyaL2c7gt1ShsA%3D%3D Occurrence Handle6691550

    Article  CAS  PubMed  Google Scholar 

  57. M Schlienger C Krzisch F Pene et al. (1989) ArticleTitleEpidermoid carcinoma of the anal canal treatment results and prognostic variables in a series of 242 cases Int J Radiat Oncol Biol Phys 17 1141–51 Occurrence Handle1:STN:280:DyaK3c%2Fptlyqtg%3D%3D Occurrence Handle2599902

    CAS  PubMed  Google Scholar 

  58. PR Fuchshuber M Rodriguez-Bigas T Weber NJ Petrelli (1997) ArticleTitleAnal canal and perianal epidermoid cancers J Am Coll Surg 185 494–505 Occurrence Handle10.1016/S1072-7515(97)00094-X Occurrence Handle1:STN:280:DyaK1c%2FhvFWgsw%3D%3D Occurrence Handle9358099

    Article  CAS  PubMed  Google Scholar 

  59. LP Leichman BJ Cummings (1990) ArticleTitleAnal carcinoma Curr Probl Cancer 14 117–59 Occurrence Handle1:STN:280:DyaK3czmtVKgtQ%3D%3D Occurrence Handle2202554

    CAS  PubMed  Google Scholar 

  60. BC Morson (1966) ArticleTitleFactors influencing the prognosis of early cancer of the rectum Proc R Soc Med 66 607–8

    Google Scholar 

  61. J Papillon M Mayer JF Montbarbon JP Gerard JL Chassard C Bailly (1983) ArticleTitleA new approach to the management of epidermoid carcinoma of the anal canal Cancer 51 1830–7 Occurrence Handle1:STN:280:DyaL3s7lsFSmsQ%3D%3D Occurrence Handle6831349

    CAS  PubMed  Google Scholar 

  62. RH Sweet (1947) ArticleTitleResults of treatment of epidermoid carcinoma of the anus and rectum Surg Gynecol Obstet 84 967–72 Occurrence Handle1:STN:280:DyaH2s%2FlslaksQ%3D%3D Occurrence Handle20295759

    CAS  PubMed  Google Scholar 

  63. WD Gabriel (1941) ArticleTitleSquamous cell carcinoma of the anus and anal canal. An analysis of 55 cases J R Soc Med 34 139–60 Occurrence Handle1:STN:280:DC%2BC3crmt1equg%3D%3D

    CAS  Google Scholar 

  64. A Devois R Decker (1960) ArticleTitleLa Curiepuncture du cancer de l’anus Arch Fr Mal Appar Dig 49 54–67

    Google Scholar 

  65. JE Dalby RS Pointon (1961) ArticleTitleThe treatment of anal carcinoma by interstitial irradiation AJR Am J Roentgenol 85 515–20 Occurrence Handle1:STN:280:DyaF3c%2FjvV2ktA%3D%3D

    CAS  Google Scholar 

  66. J Papillon (1982) Rectal and anal cancers Springer-Verlag Berlin

    Google Scholar 

  67. IG Williams (1962) ArticleTitleCarcinoma of the anus and anal canal Clin Radiol 13 30–4 Occurrence Handle1:STN:280:DyaF387pvFSrtw%3D%3D Occurrence Handle14007177

    CAS  PubMed  Google Scholar 

  68. ST Cantril JP Green GL Schall WC Schaupp (1983) ArticleTitlePrimary radiation therapy in the treatment of anal carcinoma Int J Radiat Oncol Biol Phys 9 1271–8 Occurrence Handle1:STN:280:DyaL3s3ptVeksA%3D%3D Occurrence Handle6885539

    CAS  PubMed  Google Scholar 

  69. J Papillon (1986) ArticleTitleRadiation therapy in the conservative management of cancers of the low rectum and anal canal Int J Colorectal Dis 1 251–5 Occurrence Handle10.1007/BF01648348 Occurrence Handle1:STN:280:DyaL2s3lt1Kgsw%3D%3D Occurrence Handle3598321

    Article  CAS  PubMed  Google Scholar 

  70. MM Chruscov EP Semakian BA Raifel (1978) ArticleTitleDie strahlentherapie des rektalen epidermoidkarzinomas Radiobiol Radiother (Berl) 19 683–9 Occurrence Handle1:STN:280:DyaE1M7jslKqtQ%3D%3D

    CAS  Google Scholar 

  71. RD James RS Pointon S Martin (1985) ArticleTitleLocal radiotherapy in the management of squamous carcinoma of the anus Br J Surg 72 282–5 Occurrence Handle1:STN:280:DyaL2M7nsFOkuw%3D%3D Occurrence Handle3986477

    CAS  PubMed  Google Scholar 

  72. F Eschwege N Breteau A Chavy P Lasser P Wibault J Kac (1979) ArticleTitleComplications de la radiotherapie trancutanee epitheliomas du canal anal Gastroenterol Clin Biol 3 183–6 Occurrence Handle1:STN:280:DyaE1M3jslCqsQ%3D%3D Occurrence Handle467911

    CAS  PubMed  Google Scholar 

  73. B Cummings T Keane G Thomas A Harwood W Rider (1984) ArticleTitleResults and toxicity of treatment of anal canal carcinoma by radiation therapy or radiation therapy and chemotherapy Cancer 54 2062–8 Occurrence Handle1:STN:280:DyaL2M%2FisVCksg%3D%3D Occurrence Handle6435851

    CAS  PubMed  Google Scholar 

  74. J Rousseau G Mathieu J Fenton (1979) ArticleTitleResultats et complications de la radiotherapie des epitheliomas du canal anal. Etude de 128 cas traits de 1956 a 1970 Gastroenterol Clin Biol 3 207–8

    Google Scholar 

  75. C Heidelberger L Griesbach BJ Montag et al. (1958) ArticleTitleStudies on fluorinated pyrimidines. Effects on transplanted tumors Cancer Res 18 305–17 Occurrence Handle1:CAS:528:DyaG1cXhtFKgt78%3D Occurrence Handle13523597

    CAS  PubMed  Google Scholar 

  76. MA Bagshaw (1961) ArticleTitlePossible role of potentiators in radiation therapy AJR Am J Roentgenol 85 822–33 Occurrence Handle1:STN:280:DyaF3c%2FgsFWjsw%3D%3D

    CAS  Google Scholar 

  77. T Vietti F Eggerding F Valeriote (1971) ArticleTitleCombined effect of x radiation and 5-fluorouracil on survival of transplanted leukemic cells J Natl Cancer Inst 47 865–70 Occurrence Handle1:CAS:528:DyaE38XjtVKjsA%3D%3D Occurrence Handle5097154

    CAS  PubMed  Google Scholar 

  78. JE Byfield P Calabro-Jones I Klisak F Kulhanian (1982) ArticleTitlePharmacologic requirements for obtaining sensitization of human tumor cell in vitro to combined 5-fluorouracil or ftorafur and x-rays Int J Radiat Oncol Biol Phys 8 1923–33 Occurrence Handle1:CAS:528:DyaL3sXhtVels7g%3D Occurrence Handle6818194

    CAS  PubMed  Google Scholar 

  79. RA Michaelson GB Magill SH Quan RH Leaming M Nikurui MW Stearns (1983) ArticleTitlePreoperative chemotherapy and radiation therapy in the management of anal epidermoid carcinoma Cancer 51 390–5 Occurrence Handle1:STN:280:DyaL3s7gt1Ohsg%3D%3D Occurrence Handle6401588

    CAS  PubMed  Google Scholar 

  80. ND Nigro HG Seydel B Considine VK Vaitkevicius L Leichman JJ Kinzie (1983) ArticleTitleCombined preoperative radiation and chemotherapy for squamous cell carcinoma of the anal canal Cancer 51 1826–9 Occurrence Handle1:STN:280:DyaL3s7lsFSmsA%3D%3D Occurrence Handle6831348

    CAS  PubMed  Google Scholar 

  81. DE Smith KH Shah AR Rao et al. (1994) ArticleTitleCancer of the anal canal: treatment with chemotherapy and low-dose radiation therapy Radiology 191 569–72 Occurrence Handle1:STN:280:DyaK2c3gsVansw%3D%3D Occurrence Handle8153343

    CAS  PubMed  Google Scholar 

  82. WR Meeker BJ Sickle-Santanello G Philpott et al. (1986) ArticleTitleCombined chemotherapy, radiation, and surgery for epithelial cancer of the anal canal Cancer 57 525–9 Occurrence Handle3942984

    PubMed  Google Scholar 

  83. KM Tveit KO Karlsen SD Fossa A Flokkmann I Guldvog J Haffner (1989) ArticleTitlePrimary treatment of carcinoma of the anus by combined radiotherapy and chemotherapy Scand J Gastroenterol 24 1243–7 Occurrence Handle1:STN:280:DyaK3c7gtVCnuw%3D%3D Occurrence Handle2513640

    CAS  PubMed  Google Scholar 

  84. MJ Lopez RJ Myerson SJ Shapiro et al. (1991) ArticleTitleSquamous cell carcinoma of the anal canal Am J Surg 162 580–4 Occurrence Handle10.1016/0002-9610(91)90113-R Occurrence Handle1:STN:280:DyaK2c3ntVCgsQ%3D%3D Occurrence Handle1670229

    Article  CAS  PubMed  Google Scholar 

  85. G Tanum K Tveit KO Karlsen M Hauser-Jensen (1991) ArticleTitleChemoradiotherapy of anal carcinoma: survival and late morbidity Cancer 67 2462–6 Occurrence Handle1:STN:280:DyaK3M7pvFSjuw%3D%3D Occurrence Handle2015547

    CAS  PubMed  Google Scholar 

  86. TA Rich JA Ajani WH Morrison B Levin (1993) ArticleTitleChemoradiation therapy for anal cancer: radiation plus continuous infusion of 5-fluorouracil with or without cisplatin Radiother Oncol 27 209–15 Occurrence Handle1:STN:280:DyaK2c%2FitlSluw%3D%3D Occurrence Handle8210457

    CAS  PubMed  Google Scholar 

  87. R Doci R Zucali GL Monica et al. (1996) ArticleTitlePrimary chemoradiation therapy with fluorouracil and cisolatin for cancer of the anus: results in 35 consecutive patients J Clin Oncol 14 3121–5 Occurrence Handle1:CAS:528:DyaK2sXitl2itg%3D%3D Occurrence Handle8955657

    CAS  PubMed  Google Scholar 

  88. GL Ceresoli AJM Ferreri S Cordio E Villa (1998) ArticleTitleRole of dose intensity in conservative treatment of anal canal carcinoma Oncology 55 525–32 Occurrence Handle10.1159/000011907 Occurrence Handle1:STN:280:DyaK1cvltlGgsQ%3D%3D Occurrence Handle9778618

    Article  CAS  PubMed  Google Scholar 

  89. A Allal JM Kurtz G Pipard et al. (1993) ArticleTitleChemoradiotherapy versus radiotherapy alone for anal cancer: a retrospective comparison Int J Radiat Oncol Biol Phys 27 59–66 Occurrence Handle1:STN:280:DyaK3sznsVKmsQ%3D%3D Occurrence Handle8365944

    CAS  PubMed  Google Scholar 

  90. B Sischy RL Doggett JM Krall et al. (1989) ArticleTitleDefinitive irradiation and chemotherapy for radiosensitization in management of anal carcinoma: interim report on radiation therapy oncology group study No. 8314 J Natl Cancer Inst 81 850–6 Occurrence Handle1:STN:280:DyaL1M3lvVymug%3D%3D Occurrence Handle2724350

    CAS  PubMed  Google Scholar 

  91. JA Martenson SR Lipsitz M Lefkopoulou et al. (1995) ArticleTitleResults of combined modality therapy for patients with anal cancer (E7283) Cancer 76 1731–6 Occurrence Handle1:CAS:528:DyaK28XktV2hsA%3D%3D Occurrence Handle8625041

    CAS  PubMed  Google Scholar 

  92. JA Martenson SR Lipsitz H Wagner et al. (1996) ArticleTitleInitial results of a phase 2 trial of high dose radiation therapy, 5-fluorouracil, and cisplatin for patients with anal cancer (E4292): an eastern cooperative oncology group study Int J Radiat Oncol Biol Phys 35 745–9 Occurrence Handle10.1016/0360-3016(96)00146-0 Occurrence Handle1:CAS:528:DyaK28XltFOrsrg%3D Occurrence Handle8690640

    Article  CAS  PubMed  Google Scholar 

  93. M Mahjoubi H Sadek E Francois et al. (1990) ArticleTitleEpidermoid anal canal carcinoma (EACC): activity of cisplatin (P) and continuous 5 fluorouracil (5FU) in metastatic (M) and/or local recurrent (LR) disease [abstract] Proc Annu Meet Am Soc Clin Oncol 9 114

    Google Scholar 

  94. RF Heitmiller AA Forastiere L Kleinberg M Zahurak (2000) ArticleTitleNeoadjuvant chemoradiation followed by surgery for respectable esophageal cancer Recent Results Cancer Res 155 97–104 Occurrence Handle1:STN:280:DC%2BD3c7lslKgsw%3D%3D Occurrence Handle10693242

    CAS  PubMed  Google Scholar 

  95. PB Desai JJ Vyas S Sharma et al. (1989) ArticleTitleCombined treatment modalities in esophageal cancer Semin Surg Oncol 5 365–9 Occurrence Handle1:STN:280:DyaK3c%2FkvVCmsg%3D%3D Occurrence Handle2814149

    CAS  PubMed  Google Scholar 

  96. R Brunet H Sadek J Vignoud et al. (1990) ArticleTitleCisplatin (P) and 5 fluorouracil (5FU), for the neoadjuvant treatment (Tt) of epidermoid anal canal carcinoma (EACC) [abstract] Proc Annu Meet Am Soc Clin Oncol 9 104

    Google Scholar 

  97. H Bartelink F Roelofsen F Eschwege et al. (1997) ArticleTitleConcomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of Phase 3 randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups J Clin Oncol 15 2040–9 Occurrence Handle1:CAS:528:DyaK2sXjsVCrt7k%3D Occurrence Handle9164216

    CAS  PubMed  Google Scholar 

  98. SJ Arnott JD Cunningham J Gallagher et al. (1996) ArticleTitleUKCCCR Anal Cancer Trial Working Party. Epidermoid anal cancer: results from the UKCCCR randomized trial of radiography alone versus radiotherapy, 5-fluorouracil, and mitomycin Lancet 348 1049–54 Occurrence Handle10.1016/S0140-6736(96)03409-5 Occurrence Handle8874455

    Article  PubMed  Google Scholar 

  99. L Leichman N Nigro V Vaitkevicius et al. (1985) ArticleTitleCancer of the anal canal: model for prospective adjuvant combined modality therapy Am J Med 78 211–6 Occurrence Handle10.1016/0002-9343(85)90428-0 Occurrence Handle1:STN:280:DyaL2M7hvFaquw%3D%3D Occurrence Handle3918441

    Article  CAS  PubMed  Google Scholar 

  100. JD Ellenhorn WE Enker SH Quan (1994) ArticleTitleSalvage abdominoperineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus Ann Surg Oncol 1 105–10 Occurrence Handle1:STN:280:DyaK2M7js1Sgsg%3D%3D Occurrence Handle7834434

    CAS  PubMed  Google Scholar 

  101. RS Zelnick PA Haas M Ajloun et al. (1992) ArticleTitleResults of abdominoperineal resections for failure after combination chemotherapy and radiation therapy for anal canal cancers Dis Colon Rectum 35 574–8 Occurrence Handle1:STN:280:DyaK383ms1yguw%3D%3D Occurrence Handle1587176

    CAS  PubMed  Google Scholar 

  102. MS Flam MJ John PA Mowry LJ Lovalvo LD Ramalho J Wade (1987) ArticleTitleDefinitive combined modality therapy of carcinoma of the anus: a report of 30 cases including results of salvage therapy in patients with residual disease Dis Colon Rectum 30 495–502 Occurrence Handle1:STN:280:DyaL2s3ksF2ktA%3D%3D Occurrence Handle3109860

    CAS  PubMed  Google Scholar 

  103. WE Miles (1931) ArticleTitleThe pathology of the spread of cancer of the rectum and its bearing upon the surgery of the cancerous rectum Surg Gynecol Obstet 52 350–9

    Google Scholar 

  104. H Rouvier (1938) Anatomy of the human lymphatic system Edwards Bros Ann Arbor

    Google Scholar 

  105. PG Kuehn R Beckett H Eisenberg JF Reed (1968) ArticleTitleEpidermoid carcinoma of the perianal skin and anal canal Cancer 22 932–8 Occurrence Handle1:STN:280:DyaF1M%2Fis12qsg%3D%3D Occurrence Handle5686642

    CAS  PubMed  Google Scholar 

  106. RW Carey (1984) ArticleTitleRegression of pulmonary metastases from cloacogenic carcinoma after cis-platinum/5-fluorouracil treatment J Clin Gastroenterol 6 257–9 Occurrence Handle1:STN:280:DyaL2c3htlyluw%3D%3D Occurrence Handle6539351

    CAS  PubMed  Google Scholar 

  107. JA Ajani CH Carrasco DE Jackson S Wallace (1989) ArticleTitleCombination of cisplatin plus fluoropyrimidine chemotherapy effective against liver metastases from carcinoma of the anal canal Am J Med 87 221–4 Occurrence Handle1:STN:280:DyaL1MzjtlOrtQ%3D%3D Occurrence Handle2527006 Occurrence Handle10.1016/S0002-9343(89)80702-8

    Article  CAS  PubMed  Google Scholar 

  108. G Tanum KM Trevit KO Karlsen (1993) ArticleTitleChemoradiotherapy of anal carcinoma: tumor response and acute toxicity Oncology 50 14–7 Occurrence Handle1:STN:280:DyaK3s7jtlGgsQ%3D%3D Occurrence Handle8421594 Occurrence Handle10.1159/000227140

    Article  CAS  PubMed  Google Scholar 

  109. N Wilking N Petrelli L Herrera A Mittelman (1985) ArticleTitlePhase 2 study of combination bleomycin, vincristine, and high-dose methotrexate (BOM) with leukovorin rescue in advanced squamous cell carcinoma of the anal canal Cancer Chemother Pharmacol 15 300–2 Occurrence Handle10.1007/BF00263905 Occurrence Handle1:STN:280:DyaL28%2FivVCntA%3D%3D Occurrence Handle2414024

    Article  CAS  PubMed  Google Scholar 

  110. G Tanum (1992) ArticleTitleDiagnosis and treatment of anal carcinoma: an overview Acta Oncol 31 513–8 Occurrence Handle1:STN:280:DyaK3s%2FktVemsw%3D%3D Occurrence Handle1419096

    CAS  PubMed  Google Scholar 

  111. YT Lee (1983) ArticleTitleRegional management of liver metastases Cancer Invest 1 237–57 Occurrence Handle1:STN:280:DyaL2c7ivFKkuw%3D%3D Occurrence Handle6365269

    CAS  PubMed  Google Scholar 

  112. RJ Stagg BJ Lewis MA Friedman RJ Ignoffo DC Hohn (1984) ArticleTitleHepatic arterial chemotherapy for colorectal cancer metastases to the liver Ann Intern Med 100 736–43 Occurrence Handle1:STN:280:DyaL2c7ns1yruw%3D%3D Occurrence Handle6231876

    CAS  PubMed  Google Scholar 

  113. BJ Cummings (1987) ArticleTitleCurrent management of epidermoid carcinoma of the anal canal Gastroenterol Clin North Am 30 125–43

    Google Scholar 

  114. WE Longo AM Vernava TP Wade MA Coplin KS Virgo FE Johnson (1994) ArticleTitleRecurrent squamous cell carcinoma of the anal canal. Predictors of initial treatment failure and results of salvage therapy Ann Surg 220 40–9 Occurrence Handle1:STN:280:DyaK2c3ps1Wksw%3D%3D Occurrence Handle8024357

    CAS  PubMed  Google Scholar 

  115. NJ Petrelli M Palmer L Herrera A Bhargava (1992) ArticleTitleThe utility of squamous cell carcinoma antigen for the follow-up of patients with squamous cell carcinoma of the anal canal Cancer 70 35–9 Occurrence Handle1:STN:280:DyaK383pvVaquw%3D%3D Occurrence Handle1606545

    CAS  PubMed  Google Scholar 

  116. NY Ng Ying Kin J Pigneux H Auvray R Brunet L Thomas R Denepoux (1988) ArticleTitleOur experience of conservative treatment of anal canal carcinoma combining external irradiation and interstitial implant: 32 cases treated between 1973 and 1982 Int J Radiat Oncol Biol Phys 14 253–9 Occurrence Handle1:STN:280:DyaL1c7hsVOktQ%3D%3D Occurrence Handle3338946

    CAS  PubMed  Google Scholar 

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ACKNOWLEDGMENT

The authors thank Dr. Hamish Phillips, consultant clinical oncologist, for his assistance.

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  1. Department of Colorectal Surgery, Western General Hospital, Edinburgh, Scotland, United Kingdom

    Harunobu Sato M.D., Poh-Koon Koh M.R.C.S.(Edinb.) & David C. C. Bartolo F.R.C.S.

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  1. Harunobu Sato M.D.
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  2. Poh-Koon Koh M.R.C.S.(Edinb.)
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  3. David C. C. Bartolo F.R.C.S.
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Correspondence to Poh-Koon Koh M.R.C.S.(Edinb.).

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Sato, H., Koh, PK. & Bartolo, D. Management of Anal Canal Cancer. Dis Colon Rectum 48, 1301–1315 (2005). https://doi.org/10.1007/s10350-004-0934-z

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