Current management of squamous cell carcinoma of the anal canal

The management of squamous cell carcinoma of the anal canal is controversial. Treatment currently varies from abdominoperineal resection to combined radiotherapy and chemotherapy. Our aim is to review the management of this disease and present our current treatment policies. Twenty-six patients treated at the University of Florida with surgery and adjuvant radiotherapy are compared with 12 patients treated with radiotherapy alone. The pertinent literature is reviewed to determine the role of primary surgery, the efficacy of adjuvant chemotherapy, and the optimal chemotherapy schedule. The preferred management of anal canal cancer is radiotherapy; abdominoperineal resection should be reserved for salvage after local recurrence and for patients with faecal incontinence caused by the destruction of the sphincter muscle. Adjuvant chemotherapy is probably indicated for patients with lesions that are stage T2 or larger. The optimal chemotherapy regimen consists of 5-fluorouracil and mitomycin. Preliminary data suggest that cisplatin may be substituted for mitomycin with equivalent efficacy and less toxicity.