Aim To describe a therapeutic approach, indications for abdominoperineal resection (APR), survival and oncological results for patients who received treatment in our surgical clinic for anal canal squamous cell cancer (SCC). Methods Patients were randomized into two groups according to the treatment method: Group 1-Chemoradiotherapy (CRT) without surgery, Group 2-CRT + APR. Results Eighteen patients with anal canal SCC were included in the study; 11 (61.1%) patients were in Group 1 and 7 (38.8%) in Group 2. Reasons for APR was as follows: three patients had insufficient CRT, two had recurrence after CRT, one had complete faecal incontinence and one patient had rectovaginal fistula. Overall five year survival (OS) and disease free survival (DFS) was 77.7% and 72.7%, respectively. Comparing two groups five year OS was 90.9% and 57.1%, whereas DFS was 81.8%, 57.1%, respectively (p=0.389 and 0.324, respectively). Conclusion Gold standard therapy for anal canal SCC is CRT. However, APR should be applied as an escape treatment for patients suffering from tumour progression, insufficient CRT and recurrence (30%).
Cummings B, Brierley J. Principles and practice of radiation oncology. Lippincott Williams and Wilkins; 2008. p. 1383–96.
2.
Chawla A, Willett C. Squamous cell carcinoma of the anal canal and anal margin. Hematol Oncol Clin North Am. 2001. p. 321–44.
3.
Welton M, Sharkey F, Kahlenberg M. The etiology and epidemiology of anal cancer. Surg Oncol Clin N Am. 2004. p. 263–75.
4.
Uronis H, Bendell J. Anal cancer: an overview. Oncologist. 2007. p. 524–34.
5.
Daling J, Madeleine M, Johnson L, Schwartz S, Shera K, Wurscher M, et al. Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer. 2004. p. 270–80.
6.
Ryan D, Compton C, Mayer R. Carcinoma of the anal canal. N Engl J Med. 2000. p. 792–800.
7.
Fuchshuber P, Rodriguez-Bigas M, Weber T. Petrelli NJ. Anal canal and perianal epidermoid cancers. J Am Coll Surg. 1997. p. 494–505.
8.
Scholefield J, Church J. Malignant Tumors of the Anal Canal and Anus. Saunders; 2007. p. 567–90.
9.
Whiteford M, Stevens K, Oh S, Deveney K. The evolving treatment of the anal cancer. How are we doing? Arch Surg. 2001. p. 886–91.
10.
Sato H, Koh P, Bartolo D. Management of anal canal cancer. Dis Colon Rectum. 2005. p. 1301–15.
11.
Berry J, Jay N, Cranston R, Darragh T, Holly E, Welton M, et al. Progression of anal high-grade squamous intraepithelial lesions to invasive anal cancer among HIV-infected men who have sex with men. Int J Cancer. 2014. p. 1147–55.
12.
Ortholan C, Ramaioli A, Peiffert D, Lusinchi A, Romestaing P, Chauveinc L, et al. Anal canal carcinoma: early-stage tumors < or =10 mm (T1 or Tis): therapeutic options and original pattern of local failure after radiotherapy. Int J Radiat Oncol Biol Phys. 2005. p. 479–85.
13.
Steele S, Varma M, Melton G, Ross H, Rafferty J, Buie W. Standards Practice Task Force of the American Society of Colon and Rectal Surgeons Practice parameters for anal squamous neoplasms. Dis Colon Rectum. 2012. p. 735–49.
14.
Benson Ab 3rd, Arnoletti J, Bekaii-Saab T, Chen C, Choti Y, Cooper M, et al. J Natl Compr Cancer Netw. 2012. p. 449–54.
15.
Papillon J, Montbarken J. Epidermoid carcinoma of the anal canal: a series of 276 cases. Dis Colon Rectum. 1987. p. 324–8.
16.
Jensen S, Hagen K, Harling H, Shokouh-Amiri M, Nielsen O. Long term prognosis after radical treatment for squamaous cell carcinoma of the anal canal and anal margin. Dis Colon Rectum. 1988. p. 273–8.
17.
Nigro N, Vaitkevicius V, Considine B. Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum. 1974. p. 354–61.
18.
Glynne-Jones R, Sebag-Montefiore D, Meadows H, Cunningham D, Begum R, Adab F, et al. ACT II study group. Best time to assess complete clinical response after chemoradiotherapy in squamous cell carcinoma of the anus (ACT II): a post-hoc analysis of randomised controlled phase 3 trial. Lancet Oncol. 2017. p. 347–56.
19.
Nigro N. An evaluation of combined therapy for squamous cell cancer of the anal canal. Dis Colon Rectum. 1984. p. 763–5.
20.
Cummings B, Keane T, ’sullivan O, Wong B, Catton C, C. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with without mitomycin C. Int J Radiat Oncol Biol Phys. 1991. p. 1115–25.
21.
Mullen J, Rodriguez-Bigas M, Chang G, Barcenas C, Crane C, Skibber J, et al. Results of surgical salvage after failed chemoradiation therapy for epidermoid carcinoma of the anal canal. Ann Surg Oncol. 2007. p. 478–83.
22.
Edge S, Byrd D, Compton C, Fritz A, Greene F, Trotti A. AJCC Cancer Staging Handbook. Springer; 2010. p. 165–73.
23.
Engstrom P, Benson Ab 3rd, Chen Y, Choti M, Dilawari R, Enke C, et al. National Comprehensive Cancer Network. Anal canal cancer clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2005. p. 510–5.
24.
Lefèvre J, Corte H, Tiret E, Boccara D, Chaouat M, Touboul E, et al. Abdominoperineal resection for squamous cell anal carcinoma: survival and risk factors for recurrence. Ann Surg Oncol. 2012. p. 4186–92.
25.
Nivatgongs S. Principles and Practice of Surgery for the Colon, Rectum and Anus. Quality Medical Inc; 1999. p. 447–73.
26.
Glynne-Jones R, Lim F. Anal cancer: an examination of radiotherapy strategies. Int J Radiat Oncol Biol Phys. 2011. p. 1290–301.
27.
Morton M, Melnitchouk K, Bleday R. Squamous cell carcinoma of the anal canal. Curr Probl Cancer. 2018. p. 486–92.
28.
Anal Cancer. Version 2. 2017.
29.
Faivre C, Rougier P, Ducreux M, Mitry E, Lusinchi A, Lasser P, et al. 5-fluorouracile and cisplatinum combination chemotherapy for metastatic squamous-cell anal cancer. Bull Cancer. 1999. p. 861–5.
30.
Cummings B. Metastatic anal cancer: the search forcure. Onkologie. 2006. p. 5–6.
31.
Schiller D, Cummings B, Rai S, Le L, Last L, Davey P, et al. Outcomes of salvage surgery for squamous cell carcinoma of the anal canal. Ann Surg Oncol. 2007. p. 2780–9.
32.
Mullen J, Rodriguez-Bigas M, Chang G, Barcenas C, Crane C, Skibber J, et al. Results of surgical salvage after failed chemoradiation therapy for epidermoid carcinoma of the anal canal. Ann Surg Oncol. 2007. p. 478–83.
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