Treatment of anal canal carcinoma

The treatment philosophy of anal canal carcinoma is changing. Abdominoperineal resection (APR) with a permanent colostomy is beginning to be replaced by lesser surgical techniques, such as excisional biopsy in a multimodality approach. Radical radiation therapy is capable of eradicating the primary tumor and yielding a high survival rate. External radiation therapy alone has been reported to result in 80% local control and 79% 5-year actuarial survival. Combining external radiation therapy with brachytherapy has yielded a 65% 5-year disease-free survival. Combined chemotherapy and radiation therapy, i.e., preoperative 5-fluorouracil and mitomycin C, with 3000 rad pelvic irradiation, allowed over 50% of the patients in each of two previous studies to be spared an APR. Close examination of the data shows that APR may not have been necessary in those who had it. Frequently, no disease was found in the resected specimen. When disease was present, there was a high rate of local recurrence in spite of APR. Although the ideal treatment may not be devised, patients are beginning to be cured of this disease while still retaining a functional anal sphincter.