Radiation therapy of anal carcinoma

Between 1978 and 1982, 30 consecutive patients with anal carcinoma were given radiation therapy. Irradiation alone was given to cloacogenic carcinoma and in combination with bleomycin to squamous cell carcinoma. Patients with an early tumour (T1, T2) were treated to 65 Gy (60 Gy + bleomycin) directly, whereas patients with a moderately advanced tumour (T3) were treated to the same radiation dose only if no evidence of residual disease existed after approximately 50 Gy (45 Gy + bleomycin); if a palpable tumour still remained 3 to 4 weeks after the end of the irradiation, surgery was performed. Seven of 7 patients with an early lesion (T1, T2) and 5 of 9 with a tumour in stage T3 treated according to this regime are alive with no evidence of disease and with preserved anal anatomy and function. Only one of 9 patients in stage T3 and T4, also treated with an abdominoperineal resection had viable tumour at surgery and 6 of them are alive without disease; 2 died postoperatively and one developed a recurrence in the urinary bladder. The results indicate that anal carcinomas are sensitive to radiation and often curable by irradiation.