Radiochemotherapy for anal carcinoma - effectivity and late toxicity

Radiochemotherapy of anal carcinoma is an organ-sparing approach with a high curative potential. The purpose was to evaluate the effectivity and late toxicity for patients treated with radiochemotherapy in our department.

During 1990-2000, 27 patients with anal carcinoma were treated at the Universitätsklinikum Mannheim. The median follow-up time was 23 months (max. 68 months). Before treatment, 23 patients were colostomy-free. Patients were treated according to 3 different protocols (Cummings n = 8, EORTC n = 5, RTOG n = 14). Acute toxicity was scored according to the RTOG/EORTC scale, and late toxicity according to the LENT/SOMA scale.

25 patients completed the therapy. One patient died due to leukopenic sepsis, and 1 patient interrupted therapy. 4 patients had a tumor relapse (2 patients immunosuppressed, 1 T4 tumor and 1 recurrence at the field-margin), one underwent abdomino- perineal resection. This resulted in a disease-free survival of about 80% and colostomy-free survival of 90% at 5 years. Total doses < 50 Gy and immunosuppression resulted in higher recurrence rates. Most patients suffered from acute toxicity grades 2 (n = 7) and 3 (n = 19) and late toxicity grades 1 (n = 7) and 2 (n = 4).

Radiochemotherapy for anal carcinoma is an effective therapy with acceptable toxicity. Immunosuppressed patients have a higher risk for tumor recurrences and should be monitored more closely.