[Concomitant preoperative chemoradiotherapy in the treatment of anal carcinoma]

Carcinoma of the anal canal represents about 1-2% of digestive system cancers. Its prognosis depends directly upon the size of the primary tumor and on the probability of lymphatic spread of the cancer. In the past, patients with invasive anal carcinoma were routinely treated with abdominal perineal resection. The NCCN institutions recommend that patients who have a carcinoma in situ can be cured with local excision with adequate margins. If margins are not sufficient, local radiotherapy is desirable. Patients who have a T1 lesion receive external beam radiotherapy (50-59 Gy) plus or minus mitomycin/5-fluorouracil. Patients with T2-T4 lesion, especially if inguinal nodes are positive, should receive the combination of mitomycin/5-fluorouracil plus radiotherapy (50-59 Gy) to include the inguinal and pelvic lymph node regions. Patients receiving the combination therapy (chemotherapy with radiation therapy) when compared with those with radiation therapy alone have a significantly better local control (60% versus 39%). Patients whose tumor was not eradicated are candidates for additional chemotherapy with 5-fluorouracil/cisplatin. If the local disease is persistent or progressive or if it has the local recurrence, patient becomes a candidate for an abdominoperineal resection.