Advanced anal squamous cell carcinoma -- radiotherapy or surgery?

Area of Science:

• Oncology
• Surgical Oncology
• Radiotherapy

Background:

• Anal and rectal cancers are a significant cause of mortality in Poland.
• Squamous cell carcinoma, while less common than adenocarcinoma, primarily affects the anus.
• While often responsive to radiation, some anal squamous cell carcinoma cases necessitate surgical intervention.

Purpose of the Study:

• To evaluate the efficacy of radiochemotherapy and surgical treatment for anal squamous cell carcinoma.
• To assess survival rates and complication profiles associated with different treatment modalities.

Main Methods:

• A cohort of 18 patients with anal squamous cell carcinoma were treated between 1999-2008.
• All patients received radiochemotherapy with Mitomycin, 5-Fluorouracil, and Lucovorin, with radiation doses between 45-54 Gy.
• Abdomino-perineal resection (APR) was performed in 3 patients with incomplete tumor regression.

Main Results:

• The mean observation period was 5.5 years.
• Mean survival rates were 48 months for operated patients and 55 months for conservatively treated patients (p=0.23).
• Post-operative complications occurred in 66% of surgical procedures versus 27% of teleradiotherapeutic procedures.

Conclusions:

• Combined radiotherapy and chemotherapy represent a primary treatment for anal squamous cell carcinoma.
• Surgery, specifically APR, is indicated for advanced cases with incomplete regression but is associated with high complication rates.
• Despite complications, APR remains a necessary therapeutic option for select patients.