Current management of anal canal cancer

Abstract

Squamous cell carcinoma of the anal canal historically has been treated with abdominoperineal resection, resulting in high rates of morbidity and local recurrence. Pioneering work led to the finding that radiation therapy (RT) combined with 5-fluorouracil (5-FU) and mitomycin results in high rates of local control and disease-free and colostomy-free survival without surgery. Prospective randomized trials from Europe and the United States have shown the superiority of RT, 5-FU, and mitomycin over 1) RT alone, 2) RT with 5-FU, and 3) neoadjuvant cisplatin/5-FU with concurrent radiation, cisplatin, and 5-FU. At present, RT with 5-FU and mitomycin is the standard of care for anal cancer patients. Recent advances include the integration of positron emission tomography into staging, radiation treatment planning and monitoring, and the use of intensity modulated RT. European randomized trials are further evaluating the role of cisplatin in the neoadjuvant, concurrent, and adjuvant settings, as well as radiation dose escalation. Other studies are evaluating the use of capecitabine, oxaliplatin, and the anti-epidermal growth factor receptor agent cetuximab with RT in this malignancy.

Management of Two Cases of Recurrent Anal Carcinoma

“…A recent multi-institutional study by Kachnic et al [19] reported excellent outcomes with low toxicity in the context of anal cancer treatment with dose intensity-modulated radiation therapy. Other radiation therapy approaches with promising outcomes described in the past included 3-dimensional conformational radiotherapy treatment piloted in a phase II study [20], intensity-modulated radiation therapy [21] and sequential intensity-modulated radiation therapy in a combined chemoradiological approach [22]. Improvements in radiation treatments in combination with optimization of chemotherapy may result in reduced toxicities, better outcomes and superior quality of life.…”

Neoplasms of Anal Canal and Perianal Skin

“…Mitomycin is associated with a 60% incidence of serious (grade 3-4) hematologic, pulmonary, renal toxic events and also hemolytic-uremic syndrome. 33 Cisplatin has also been used in anal canal SCC chemoradiotherapy regimes producing less toxicity than mitomycin with reasonable response rates. The first high-level evidence study, RTOG 98-11, found a higher rate of colostomy formation in the cisplatin group (19% vs 10%) compared with the mitomycin group, suggesting response rates may not be as good.…”

Validation and use of microdialysis for determination of pharmacokinetic properties of the chemotherapeutic agent mitomycin C - an experimental study

“…Although mostly replaced by drugs with higher response rate and less toxicity, it still plays a role in curative treatment of anal cancer in combination with 5-flurouracil and radiation therapy and is also used in palliative chemotherapy [2,3]. The wide clinical anti-cancer effect in combination with specific properties such as non-cell cycle specific and direct cytotoxic effect has also rendered MMC an attractive drug for use by topical administration, utilized in the treatment of as diverse malignancies as bladder cancer and certain tumors of the eye [4,5].…”