Dynamic management of squamous cell cancer of the anal canal

For many years the accepted treatment for squamous cell cancer of the anal canal has been abdominoperineal resection of the rectum. Recently, high dose radiation therapy has been advocated by some, and we initiated a study using a combination of radiation, chemotherapy and surgery. This review includes 44 patients treated by us from December 1971 to July 1983. We discontinued routine operation after 1975 because chemoradiation therapy eliminated the primary lesion in most patients. In fact, the gross lesion disappeared in 40 patients, 13 of whom had radical operations done on routine basis. Four operations were done for residual disease after chemoradiation treatment and one for local recurrence. The corrected, projected five year survival rate was 79% with a follow-up of at least four years in all patients. Most failures occurred in patients with large primary tumors, all of whom had radical operations after the preoperative therapy. This experience suggests that patients with primary lesions over 5 cm in maximum diameter should have an additional course of chemoradiation and/or abdominoperineal resection on a routine basis.