Effectiveness of surgical salvage therapy for patients with locally uncontrolled anal carcinoma after sphincter-conserving treatment

Abstract

BACKGROUND Locally persistent or recurrent anal carcinoma represents a clinically significant problem, the management of which remains the subject of some controversy. Although the few current data suggest that radical surgery remains the sole salvage treatment able to provide some chance of cure, some authors have reported disappointingly low success rates. The current study presents the outcome of patients who failed locally after receiving radiotherapy or chemoradiotherapy for anal carcinoma. METHODS Of 185 consecutive patients treated between January 1976 and December 1996 with sphincter conservation, 42 subsequently presented with local failure, either alone (27 patients) or with regional or distant metastases (15 patients). Nine patients (21%) received supportive care only, 7 patients (17%) received palliative therapy, and 26 patients (62%) underwent potentially curative surgical salvage treatment, including 23 abdominoperineal resections (APR) and 3 local excisions. The median follow‐up after local failure for all patients was 21.5 months (range, 1–231 months). RESULTS With the exception of 2 patients who committed suicide, all patients who did not undergo surgical salvage therapy died of progressive disease. Among 26 patients who received curative treatment, 11 ultimately achieved disease control. The 5‐year overall survival rate after the diagnosis of local failure was 28% for all patients and 44.5% for those receiving curative salvage treatment. For the latter group the 5‐year actuarial secondary local and locoregional control rates were 53% and 43%, respectively. CONCLUSIONS Although APR no longer is the first‐line treatment of patients with anal carcinoma, it continues to play an essential role in salvage therapy, resulting in ultimate disease control in approximately 50% of patients with isolated local failure. The curative potential of secondary surgical treatment suggests the possible importance of early detection of persistent or recurrent local disease after nonsurgical, sphincter‐conserving therapy. Cancer 1999;86:405–9. © 1999 American Cancer Society.

Photodynamic therapy for anal cancer

“…However, many patients with bulky primary anal tumors fail locally and undergo salvage exonerative types of surgery with loss of a still functioning sphincter [4]. In select patients perhaps further salvage therapy directed to the recurrent anal tumor bed may be possible.…”

Surgical salvage therapy of anal canal cancer

“…There was a better 10-year survival among patients with recurrences compared with that in patients with a persistent disease. These findings are consistent with those of Nilssio et al [22] , who reported a significantly better 5-year survival among patients with recurrences (82% versus 33%) and Allal et al [17] (56% versus 23%), but contradicted with those of Pocard et al [16] , who reported that patients with a persistent disease had a longer survival time (74 versus 25 months). The difference may be related to the tumors' stage and nodal status at initial presentation, or, alternatively, may reflect more aggressive biologic phenotypes of tumors that are different in response to radiotherapy.…”

“…Surgical resection was often recommended as the most appropriate salvage method [13][14][15] . The overall survival rate for surgical salvage at 5 years was about 30-60% [16,17] . Some investigators reported disappointingly low success rates [18] and alternative approaches have been suggested, such as low dose radiotherapy or combined chemoradiotherapy [19] .…”

“…Earlier investigators reported the perineal wound complication rate was up to 30% [16,17,21] . In the study by Nilsson et al [22] , the rate of delayed healing was 66 % (22 of 35).…”

Carcinoma of the Anus: Strategies in Management

“…Others with larger residual disease receive salvage APR. The overall survival data for surgical salvage at 5 years is about 30%-60% [77,78]. Some use, as an option, a repeat combined chemoradiation treatment for salvage purposes, with comparable success.…”