Conservative treatment of anal carcinoma with chemotherapy and radiation therapy

Carcinoma of the anus is a disease that is well treated with chemoradiation therapy. Moderate doses of radiation therapy provide excellent results for T1 lesions and, when salvage treatment is included, for T2 and T3 lesions. Two recently completed European trials (EORTC and UKCCCR) have compared treatment with radiation therapy alone with chemoradiation. Both trials showed a better disease-free survival and a better colostomy-free survival when chemotherapy was added. In the United States, the RTOG has completed a trial evaluating the role of mitomycin-C. RTOG 87-04 compared results with RT plus 5FU plus mitomycin-C: this addition improved disease-free survival and colostomy-free survival. The post-treatment follow-up of patients with anal carcinoma is critical since approximately half of patients with persistent or recurrent disease can be salvaged, frequent follow-up visits with careful physical exam are mandatory.