Recurrent Squamous Cell Carcinoma of the Anal Canal Predictors of Initial Treatment Failure and Results of Salvage Therapy

Abstract

ObjectiveThe outcomes of patients with squamous cell carcinoma of the anal canal treated by either sphincter-preserving procedures or radical surgery were evaluated, with the goals of identifying factors predicting treatment failure and quantifying results of salvage therapy in patients with recurrent disease. Basic ProceduresA population-based study on all patients in all 159 hospitals of the Department of Veterans Affairs (VA) from 1987 to 1991 was carried out. Data were compiled from several national computerized VA data sets. Supplementary information from local tumor registrars also was obtained, including demographic information, discharge summaries, operative reports, pathology reports, and medical oncology and radiation oncology summaries. From these sources, information on tumor histology, tumor stage, tumor grade, presence of regional or distant metastases, surgical procedures, use of chemotherapy and radiation therapy (RT), toxicity of chemotherapy and RT, development of recurrent disease, treatment of recurrence, survival, and cause of death were obtained. Main FindingsFour hundred five patients with anal cancer were identified by computer search, and 204 (51 %) were evaluable; 164 of 204 (80%) had squamous cell carcinoma, 137 of whom (84%) were treated with sphincter-preserving procedures, and 27 of whom (16%) were treated by by radical surgery. One hundred fourteen of 138 (83%) were treated by multimodality therapy, which we defined as local excision followed by chemotherapy and RT. The mean dose of RT among patients treated by multimodality therapy was 4200 ± 540 cGy and 82% of those treated with multimodality therapy received 5-FU/mitomycin C. Recurrent disease was diagnosed in 43 of all 149 patients (29%) with potentially curable disease. (stages I-l1l) Multivariate analysis revealed that stage at diagnosis (p = 0.04) and method of treatment (p = 0.03) were the sole predictors of recurrence. Fifty-three percent of patients who underwent salvage abdominoperineal resection (APR) are alive, whereas only 19% who underwent salvage chemotherapy with or without RT are alive. Principal ConclusionsThese data indicate that multimodality therapy currently is being employed in the majority of patients with squamous cell carcinoma of the anal canal in the VA system. Tumor stage and 40

Surgical salvage therapy of anal canal cancer

“…In the present study, six of the 16 patients who underwent appropriate surgical treatment survived for more than 10 years. These results are similar to those of Longo et al [20] , who reported a survival rate of 53% among 17 patients and Ellenhorn et al [21] , who noted that 44% of 38 patients survived for 5 years after salvage resection.…”

Results of Surgical Salvage Treatment for Anal Canal Cancer: A Retrospective Analysis with Overview of the Literature

“…In 2 different studies, Nigro [16] and Flam et al [19] recommended a second course of CRT for patients with macroscopic disease. In the study of Longo et al [20] , salvage CRT has been shown to have 19% of survival rate, while Flam et al [21] reported a 50% survival. On the other hand, other studies showed 5-year survival rates after APR ranging from 30 to 60% [22,23] .…”

Carcinoma espinocelular de canal anal: análise de 11 casos

“…Devido a este fato, ao tipo de cirurgia mutiladora necessária para ressecção destes tumores com conseqüente colostomia definitiva e aos bons resultados observados em outras neoplasias espinocelulares, como nos tumores de laringe, a quimioterapia e a radioterapia tornaramse o tratamento de eleição destes doentes. Após o término do tratamento, a lesão local deve ser avaliada; se persistente deverá, então, ser ressecada cirurgicamente (21,23,30) . A principal droga quimioterápica usada tem sido a 5-FU combinada com a mitocina e/ou cisplatina por 4 a 5 dias (9,24,28,29,30,32,33) .…”