Treatment of epidermoid anal canal cancer

Between 1968 and 1979, 183 patients with invasive epidermoid cancer of the anal canal were treated at Institut Curie. There was 156 women, 27 men with a mean age of 67 +/- 11 years (range 40 to 85 years). The initial height of the tumor was less than 4 cm (65 patients), 4 to 6 cm (98 patients), and more than 6 cm (20 patients). All the patients received radiotherapy, either preoperatively or as curative procedure. Twenty-five patients received preoperative radiotherapy, and there was no residual tumor in 9 biopsies obtained at operation. Four local recurrences were observed. One hundred fifty-eight patients received curative radiotherapy, 115 of whom did not undergo operation. Eighty were alive with no evidence of disease and good anal function with a minimum of 3 years follow-up. We observed 15 local recurrences, 4 inguinal recurrences, and 8 visceral metastases. In addition, eight patients initially had such a big tumor that radiotherapy was only a palliative procedure. Forty-three patients required a surgical procedure after this curative radiotherapy. Colostomy (12 patients) or abdominoperineal amputation (25 patients) was required for local recurrence and colostomy was required for necrosis related to radiotherapy. Five year survival was 59 percent. The survival was related to the size of the tumor (p less than 0.0001). The likelihood of retaining normal anal function with local control of the tumor was also closely related to the initial size of the tumor.