Chemoradiotherapy of anal cancer – a report of 12 cases
Abstract
Between 1991 and 1996, 12 patients (9 males and 3 females) with squamous-cell anal carcinoma, stage TI-3 NO-3MO, were treated at our institution with concomitant chemotherapy and radiation. Median age of patients was 57 years (range 38–70 years.)
Ten patients received radiotherapy to the pelvis and inguinal lymph nodes at the dose of 30 Gy. After planned interval (average 11 days), patients received a bost of 16–20 Gy to the tumor. Two remaining patients were irradiated to the pelvis (50 Gy in one patient, 45 Gy and then boost of 15 Gy in the second one). Daily dosas of 1.8 to 2.0 Gy, 5 times per week, were used. Concomitant chemotherapy included Mitomycin C (10–15 mg/m2, day 1) and 5 Fluorouracil (750 mg/m2, days 1–4 or 1–5) delivered at the beginning (twelve pts) or at the beginning and at the end of treatment (seven pts).
In the patients (83%) complete clinical remission (CR) was achieved, confirmed by negative biopsy fram the site of primary tumour in five cases. All patients with CR remain free of disease for a median of 18 months (range: 7–70 months).
Surgery (abdomino-perineal resection) was performed in the two patients who achieved only partiaI response. One of them remains free of disease 48 months after chemoradiotherapy and the another is alive with disease dissemination to the liver, which occured 9 months after completion of radiotherapy.
Treatment tolerance was acceptable. Three patients experienced WHO grade 3 neutropenia. Late complications were observed in three patients (25%) and included intermittent stool incontinence (two pts) and erection disorders (one pt).
The results of this analysis remain in accordance with the literature data and confirm the role of conservative management of anal cancer.