[Treatment of inguinal lymph node recurrence after chemo-radiation for anal canal squamous carcinoma]

Although it is well established that the standard primary treatment for anal canal squamous cell carcinoma is chemoradiation, the strategy varies for recurrence cases.

A 76-year-old woman was diagnosed by biopsy as Stage II (T2N0M0) squamous cell cancer and treated with a total amount of 60 Gy pelvic radiation excluding the groin area, and oral chemotherapy of S-1 (60 mg/m2/day) for 4 weeks. Two years after initial therapy, she had a recurrence at the right inguinal lymph nodes. We resected her right inguinal lymph nodes and added 20 Gy photon radiations to both sides of the inguinal area. She has been recurrence-free for 4 years after the surgery. For recurrent anal canal squamous cell carcinoma, salvage surgery for the original lesion and systemic chemotherapy for distant metastasis are the standard strategy. For inguinal lymph node metastasis such as in this case, unilateral lymph node resection and adjuvant radiation for the bilateral groin area are recommended by the guidelines of National Comprehensive Cancer Network (NCCN).