Respective roles of radiotherapy and surgery in the management of epidermoid carcinoma of the anal margin

Abstract

The study of 54 patients treated curatively by irradiation with or without surgery is reported. The crude and cancer-specific five-year survival rates are 59.2 percent and 79.7 percent. Three patients were treated palliatively. The great variation in histologic type, clinical appearance, disease stage, and patient status justifies the definition of a treatment strategy using radiotherapy, surgery, or a combination of the two methods. T1 and T2 squamous- or basal-cell carcinomas are suitable for local excision followed by irradiation or for irradiation alone. T3 tumors and Bowen's disease should be treated by irradiation first. Verrucous carcinoma is suitable for local surgery followed by irradiation. Mucoepidermoid carcinoma and T4 tumors are suitable for preoperative irradiation and delayed surgery. The optimal radiation technique consists of delivering a dose of 40 Gy in 17 days by cobalt-60 with bolus and in combination with concomitant chemotherapy (5-fluorouracil and mitomycin C). Prophylactic irradiation of the inguinal area is recommended in all NO tumors except for T1 lesions and basal-cell carcinomas.

An unusual late radiotherapy-related complication requiring surgery in anal canal carcinoma

“…The acute radiation-related damage of the tissues is increased when chemotherapeutic drugs are associated [20,21]. Late complications (sphincterial tone alterations with reduced anal continence, persistent anal ulcer, rectovaginal or entero-enteric fistulae, skin sclerosis, necrosis, and organ damage) have been reported in 6%-14% of the patients [5,6,13,15,16,[21][22][23][24][25][26][27]. Complications related to the radiation treatment of inguinal lymphatic metastases (femoral head or neck fractures, leg lymphedema) have been reported as well (Table 2).…”

Long-Term Outcome after Combined Radiochemotherapy for Anal Cancer – Retrospective Analysis of Efficacy, Prognostic Factors, and Toxicity

“…This may explain the lack of statistical significance for overall survival and CFS in our analysis. Other authors also found tumor site at the anal margin to be associated with inferior prognosis [32][33][34]. The reason for the inferior prognosis of tumors at the anal margin is still unclear.…”

Squamous cell carcinoma of the anal margin

“…Some authors have observed a slight female predominance while others report an equal or male predominant distribution [5,[7][8][9][10][11]. Presenting symptoms include pain, bleeding, palpable mass, change in bowel habits, hemorrhoids, discharge, and weight loss [4,5].…”