Combined radiation and chemotherapy for carcinoma of the anal canal.

Sphincter-preserving treatment with combined radiation and chemotherapy has replaced abdominoperineal resection as the standard of care for patients with carcinoma of the anal canal. Randomized studies have shown that the combination of radiation therapy, fluorouracil (5-FU), and mitomycin (Mutamycin) is superior to radiation alone or to radiation combined with 5-FU in these patients and that the colostomy-free survival rate is 71%. Research is underway to determine whether other combinations, such as higher doses of radiation with 5-FU and cisplatin (Platinol), will result in lower or equivalent toxicity or better locoregional control and potentially improved survival. Currently, radiation combined with 5-FU and mitomycin remains the treatment of choice in most patients with carcinoma of the anal canal.