[Interdisciplinary therapy of anal carcinoma]

Primary radiation therapy is a safe sphincter sparing treatment for anal carcinomas less than 4 cm. In larger tumors results have improved dramatically in recent years by use of chemoradiation. Simultaneous radiochemotherapy of anal carcinoma leads to a 5-year survival rate of 80% with only 3 to 8% severe side effects, a local control of 75% and a conservation of sphincter function in 80%. If the tumor is smaller than 4 cm, radiotherapy alone is sufficient in patients with contraindications for chemotherapy; however, the risk of severe late side effects increases to 10%. A colostomy is indicated in patients with severe or complete stenosis of the anal canal with incontinence or obstruction by the tumor, in case of tumor nonresponding to radiotherapy or inoperable with painful defecation. Abdominoperineal resection should be limited to residual tumors increasing two months after radiotherapy, to salvage after relapse, to fistulas and necroses developing as complications of radiotherapy, to ulcers and fecal incontinence and to cases of a extended primary tumor (T4). Clinically suspicious lymph nodes should be biopsied. Histologically positive inguinal nodes should be treated with radiochemotherapy without groin dissection. A monthly follow-up is necessary in cases with residual tumor. If the size of the tumor increases, a biopsy is indicated. In case of relapse a second radiochemotherapy should be considered. Otherwise an abdominoperineal resection is indicated.