BACKGROUND

To evaluate anus-preservation treatment for anal cancer.

METHODS

Review of 42 patients (24 M/18 F; median age, 70 years; range, 13-95) with stage I-IIIB disease (squamous cell carcinoma [SqCC], 33; adenocarcinoma, 9) who received curative radiotherapy between 1991 and 2004. Eleven patients had prior surgical excision. Radiotherapy comprised lower-pelvis irradiation with boost to primary tumor (median lower-pelvis dose, 45 Gy; range, 17.2-59; median primary-site dose, 56 Gy; range, 40-72). Of 31 patients receiving concurrent chemoradiotherapy, 25 received 5-fluorouracil/mitomycin-C.

RESULTS

Median follow-up was 32 months. The most common toxicity was dermatological; 25 patients (59%) developed moderate-to-severe wet desquamation. Radiotherapy was interrupted in 18 patients (43%). The complete response rate was 67% (SqCC, 23/33; adenocarcinoma, 5/9); of 12 patients who failed treatment, primary tumor was the recurrent site in seven (median failure time, 5 months): six patients underwent salvage abdominoperineal resection. Three-year overall (OS) and disease-free survival (DFS) were 53% and 64%. Five-year functional anus-preservation rate was 64%. In multivariate analysis, OS was affected by performance status (P < 0.001), N stage (P = 0.009), and pathological type (P = 0.006). Only N stage (P = 0.001) affected DFS.

CONCLUSION

With careful monitoring of toxicity, non-surgical anus-preservation treatment with good tumor control is feasible.