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. 1994 Jul;220(1):40–49. doi: 10.1097/00000658-199407000-00007

Recurrent squamous cell carcinoma of the anal canal. Predictors of initial treatment failure and results of salvage therapy.

W E Longo 1, A M Vernava 3rd 1, T P Wade 1, M A Coplin 1, K S Virgo 1, F E Johnson 1
PMCID: PMC1234285  PMID: 8024357

Abstract

OBJECTIVE: The outcomes of patients with squamous cell carcinoma of the anal canal treated by either sphincter-preserving procedures or radical surgery were evaluated, with the goals of identifying factors predicting treatment failure and quantifying results of salvage therapy in patients with recurrent disease. BASIC PROCEDURES: A population-based study on all patients in all 159 hospitals of the Department of Veterans Affairs (VA) from 1987 to 1991 was carried out. Data were compiled from several national computerized VA data sets. Supplementary information from local tumor registrars also was obtained, including demographic information, discharge summaries, operative reports, pathology reports, and medical oncology and radiation oncology summaries. From these sources, information on tumor histology, tumor stage, tumor grade, presence of regional or distant metastases, surgical procedures, use of chemotherapy and radiation therapy (RT), toxicity of chemotherapy and RT, development of recurrent disease, treatment of recurrence, survival, and cause of death were obtained. MAIN FINDINGS: Four hundred five patients with anal cancer were identified by computer search, and 204 (51%) were evaluable; 164 of 204 (80%) had squamous cell carcinoma, 137 of whom (84%) were treated with sphincter-preserving procedures, and 27 of whom (16%) were treated by by radical surgery. One hundred fourteen of 138 (83%) were treated by multimodality therapy, which we defined as local excision followed by chemotherapy and RT. The mean dose of RT among patients treated by multimodality therapy was 4200 +/- 540 cGy and 82% of those treated with multimodality therapy received 5-FU/mitomycin C. Recurrent disease was diagnosed in 43 of all 149 patients (29%) with potentially curable disease. (stages I-III) Multivariate analysis revealed that stage at diagnosis (p = 0.04) and method of treatment (p = 0.03) were the sole predictors of recurrence. Fifty-three percent of patients who underwent salvage abdominoperineal resection (APR) are alive, whereas only 19% who underwent salvage chemotherapy with or without RT are alive. PRINCIPAL CONCLUSIONS: These data indicate that multimodality therapy currently is being employed in the majority of patients with squamous cell carcinoma of the anal canal in the VA system. Tumor stage and method of treatment appear to affect the likelihood of development of recurrent disease. Salvage APR has curative potential. Results with salvage chemotherapy and RT are disappointing.

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Selected References

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  1. Adam Y. G., Efron G. Current concepts and controversies concerning the etiology, pathogenesis, diagnosis, and treatment of malignant tumors of the anus. Surgery. 1987 Mar;101(3):253–266. [PubMed] [Google Scholar]
  2. Ajani J. A., Carrasco C. H., Jackson D. E., Wallace S. Combination of cisplatin plus fluoropyrimidine chemotherapy effective against liver metastases from carcinoma of the anal canal. Am J Med. 1989 Aug;87(2):221–224. doi: 10.1016/s0002-9343(89)80702-8. [DOI] [PubMed] [Google Scholar]
  3. Beahrs O. H., Wilson S. M. Carcinoma of the anus. Ann Surg. 1976 Oct;184(4):422–428. doi: 10.1097/00000658-197610000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Boey J., Wong J., Ong G. B. Epidermoid carcinoma of the anus. Aust N Z J Surg. 1982 Oct;52(5):521–524. doi: 10.1111/j.1445-2197.1982.tb06044.x. [DOI] [PubMed] [Google Scholar]
  5. Carey R. W. Regression of pulmonary metastases from cloacogenic carcinoma after cis-platinum/5-fluorouracil treatment. J Clin Gastroenterol. 1984 Jun;6(3):257–259. [PubMed] [Google Scholar]
  6. Cho C. C., Taylor C. W., 3rd, Padmanabhan A., Arnold M. W., Aguilar P. S., Meesig D. M., Hartmann R. S., Khanduja K. S., Rahman S. M., Stewart W. R. Squamous-cell carcinoma of the anal canal: management with combined chemo-radiation therapy. Dis Colon Rectum. 1991 Aug;34(8):675–678. doi: 10.1007/BF02050349. [DOI] [PubMed] [Google Scholar]
  7. Conte C. C., Ergin M. T., Ricci A., Jr, Deckers P. J. Clinical and pathologic prognostic variables in oropharyngeal squamous cell carcinoma. Am J Surg. 1989 Jun;157(6):582–584. doi: 10.1016/0002-9610(89)90706-x. [DOI] [PubMed] [Google Scholar]
  8. Cummings B. J. Concomitant radiotherapy and chemotherapy for anal cancer. Semin Oncol. 1992 Aug;19(4 Suppl 11):102–108. [PubMed] [Google Scholar]
  9. Cummings B. J., Keane T. J., O'Sullivan B., Wong C. S., Catton C. N. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C. Int J Radiat Oncol Biol Phys. 1991 Oct;21(5):1115–1125. doi: 10.1016/0360-3016(91)90265-6. [DOI] [PubMed] [Google Scholar]
  10. Cummings B. J., Thomas G. M., Keane T. J., Harwood A. R., Rider W. D. Primary radiation therapy in the treatment of anal canal carcinoma. Dis Colon Rectum. 1982 Nov-Dec;25(8):778–782. doi: 10.1007/BF02553310. [DOI] [PubMed] [Google Scholar]
  11. Cummings B., Keane T., Thomas G., Harwood A., Rider W. Results and toxicity of the treatment of anal canal carcinoma by radiation therapy or radiation therapy and chemotherapy. Cancer. 1984 Nov 15;54(10):2062–2068. doi: 10.1002/1097-0142(19841115)54:10<2062::aid-cncr2820541004>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  12. DALBY J. E., POINTON R. S. The treatment of anal carcinoma by interstitial irradiation. Am J Roentgenol Radium Ther Nucl Med. 1961 Mar;85:515–520. [PubMed] [Google Scholar]
  13. Doci R., Zucali R., Bombelli L., Montalto F., Lamonica G. Combined chemoradiation therapy for anal cancer. A report of 56 cases. Ann Surg. 1992 Feb;215(2):150–156. doi: 10.1097/00000658-199202000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Dubois J. B., Garrigues J. M., Pujol H. Cancer of the anal canal: report on the experience of 61 patients. Int J Radiat Oncol Biol Phys. 1991 Mar;20(3):575–580. doi: 10.1016/0360-3016(91)90072-c. [DOI] [PubMed] [Google Scholar]
  15. Flam M. S., John M. J., Mowry P. A., Lovalvo L. J., Ramalho L. D., Wade J. Definitive combined modality therapy of carcinoma of the anus. A report of 30 cases including results of salvage therapy in patients with residual disease. Dis Colon Rectum. 1987 Jul;30(7):495–502. doi: 10.1007/BF02554777. [DOI] [PubMed] [Google Scholar]
  16. Goldman S., Auer G., Erhardt K., Seligson U. Prognostic significance of clinical stage, histologic grade, and nuclear DNA content in squamous-cell carcinoma of the anus. Dis Colon Rectum. 1987 Jun;30(6):444–448. doi: 10.1007/BF02556494. [DOI] [PubMed] [Google Scholar]
  17. Goldman S., Glimelius B., Påhlman L., Ståhle E., Wilander E. Anal epidermoid carcinoma: a population-based clinico-pathological study of 164 patients. Int J Colorectal Dis. 1988 Jun;3(2):109–118. doi: 10.1007/BF01645315. [DOI] [PubMed] [Google Scholar]
  18. Greenall M. J., Quan S. H., Urmacher C., DeCosse J. J. Treatment of epidermoid carcinoma of the anal canal. Surg Gynecol Obstet. 1985 Dec;161(6):509–517. [PubMed] [Google Scholar]
  19. Habr-Gama A., da Silva e Sousa Júnior A. H., Nadalin W., Gansl R., da Silva J. H., Pinotti H. W. Epidermoid carcinoma of the anal canal. Results of treatment by combined chemotherapy and radiation therapy. Dis Colon Rectum. 1989 Sep;32(9):773–777. doi: 10.1007/BF02562127. [DOI] [PubMed] [Google Scholar]
  20. Hughes L. L., Rich T. A., Delclos L., Ajani J. A., Martin R. G. Radiotherapy for anal cancer: experience from 1979-1987. Int J Radiat Oncol Biol Phys. 1989 Dec;17(6):1153–1160. doi: 10.1016/0360-3016(89)90520-8. [DOI] [PubMed] [Google Scholar]
  21. Hussain M., al-Sarraf M. Anal carcinomas: new combined modality treatment approaches. Oncology (Williston Park) 1988 Feb;2(2):42–48. [PubMed] [Google Scholar]
  22. Martinez A., Edmundson G. K., Cox R. S., Gunderson L. L., Howes A. E. Combination of external beam irradiation and multiple-site perineal applicator (MUPIT) for treatment of locally advanced or recurrent prostatic, anorectal, and gynecologic malignancies. Int J Radiat Oncol Biol Phys. 1985 Feb;11(2):391–398. doi: 10.1016/0360-3016(85)90163-4. [DOI] [PubMed] [Google Scholar]
  23. Nigro N. D. An evaluation of combined therapy for squamous cell cancer of the anal canal. Dis Colon Rectum. 1984 Dec;27(12):763–766. doi: 10.1007/BF02553933. [DOI] [PubMed] [Google Scholar]
  24. Nigro N. D., Seydel H. G., Considine B., Vaitkevicius V. K., Leichman L., Kinzie J. J. Combined preoperative radiation and chemotherapy for squamous cell carcinoma of the anal canal. Cancer. 1983 May 15;51(10):1826–1829. doi: 10.1002/1097-0142(19830515)51:10<1826::aid-cncr2820511012>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  25. Nigro N. D., Vaitkevicius V. K., Buroker T., Bradley G. T., Considine B. Combined therapy for cancer of the anal canal. Dis Colon Rectum. 1981 Mar-Apr;24(2):73–75. doi: 10.1007/BF02604287. [DOI] [PubMed] [Google Scholar]
  26. Nigro N. D., Vaitkevicius V. K., Considine B., Jr Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum. 1974 May-Jun;17(3):354–356. doi: 10.1007/BF02586980. [DOI] [PubMed] [Google Scholar]
  27. Papillon J., Montbarbon J. F. Epidermoid carcinoma of the anal canal. A series of 276 cases. Dis Colon Rectum. 1987 May;30(5):324–333. doi: 10.1007/BF02555448. [DOI] [PubMed] [Google Scholar]
  28. Papillon J. Radiation therapy in the management of epidermoid carcinoma of the anal region. Dis Colon Rectum. 1974 Mar-Apr;17(2):181–187. doi: 10.1007/BF02588101. [DOI] [PubMed] [Google Scholar]
  29. Pintor M. P., Northover J. M., Nicholls R. J. Squamous cell carcinoma of the anus at one hospital from 1948 to 1984. Br J Surg. 1989 Aug;76(8):806–810. doi: 10.1002/bjs.1800760814. [DOI] [PubMed] [Google Scholar]
  30. Quan S. H. Anal and para-anal tumors. Surg Clin North Am. 1978 Jun;58(3):591–603. doi: 10.1016/s0039-6109(16)41541-0. [DOI] [PubMed] [Google Scholar]
  31. Salem P. A., Habboubi N., Anaissie E., Brihi E. R., Issa P., Abbas J. S., Khalyl M. F. Effectiveness of cisplatin in the treatment of anal squamous cell carcinoma. Cancer Treat Rep. 1985 Jul-Aug;69(7-8):891–893. [PubMed] [Google Scholar]
  32. Salmon R. J., Zafrani B., Labib A., Asselain B., Girodet J. Prognosis of cloacogenic and squamous cancers of the anal canal. Dis Colon Rectum. 1986 May;29(5):336–340. doi: 10.1007/BF02554126. [DOI] [PubMed] [Google Scholar]
  33. Sawyers J. L. Current management of carcinoma of the anus and perianus. Am Surg. 1977 Jul;43(7):424–429. [PubMed] [Google Scholar]
  34. Shepherd N. A., Scholefield J. H., Love S. B., England J., Northover J. M. Prognostic factors in anal squamous carcinoma: a multivariate analysis of clinical, pathological and flow cytometric parameters in 235 cases. Histopathology. 1990 Jun;16(6):545–555. doi: 10.1111/j.1365-2559.1990.tb01159.x. [DOI] [PubMed] [Google Scholar]
  35. Stearns M. W., Jr, Urmacher C., Sternberg S. S., Woodruff J., Attiyeh F. Cancer of the anal canal. Curr Probl Cancer. 1980 Jun;4(12):1–44. doi: 10.1016/s0147-0272(80)80015-8. [DOI] [PubMed] [Google Scholar]
  36. Tanum G. Treatment of relapsing anal carcinoma. Acta Oncol. 1993;32(1):33–35. doi: 10.3109/02841869309083882. [DOI] [PubMed] [Google Scholar]
  37. Tanum G., Tveit K., Karlsen K. O., Hauer-Jensen M. Chemotherapy and radiation therapy for anal carcinoma. Survival and late morbidity. Cancer. 1991 May 15;67(10):2462–2466. doi: 10.1002/1097-0142(19910515)67:10<2462::aid-cncr2820671012>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  38. Tveit K. M., Karlsen K. O., Fosså S. D., Flokkmann A., Guldvog I., Haffner J. Primary treatment of carcinoma of the anus by combined radiotherapy and chemotherapy. Scand J Gastroenterol. 1989 Dec;24(10):1243–1247. doi: 10.3109/00365528909090794. [DOI] [PubMed] [Google Scholar]
  39. Wilking N., Petrelli N., Herrera L., Mittelman A. Phase II study of combination bleomycin, vincristine and high-dose methotrexate (BOM) with leucovorin rescue in advanced squamous cell carcinoma of the anal canal. Cancer Chemother Pharmacol. 1985;15(3):300–302. doi: 10.1007/BF00263905. [DOI] [PubMed] [Google Scholar]
  40. Wilking N., Petrelli N., Herrera L., Mittelman A. Phase II study of combination bleomycin, vincristine and high-dose methotrexate (BOM) with leucovorin rescue in advanced squamous cell carcinoma of the anal canal. Cancer Chemother Pharmacol. 1985;15(3):300–302. doi: 10.1007/BF00263905. [DOI] [PubMed] [Google Scholar]
  41. Zelnick R. S., Haas P. A., Ajlouni M., Szilagyi E., Fox T. A., Jr Results of abdominoperineal resections for failures after combination chemotherapy and radiation therapy for anal canal cancers. Dis Colon Rectum. 1992 Jun;35(6):574–578. doi: 10.1007/BF02050538. [DOI] [PubMed] [Google Scholar]
  42. Zucali R., Doci R., Bombelli L. Combined chemotherapy--radiotherapy of anal cancer. Int J Radiat Oncol Biol Phys. 1990 Nov;19(5):1221–1223. doi: 10.1016/0360-3016(90)90234-b. [DOI] [PubMed] [Google Scholar]

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