SYNCHRONOUS CHEMOTHERAPY AND RADIOTHERAPY FOR CARCINOMA OF THE ANAL CANAL—AN ALTERNATIVE TO ABDOMINOPERINEAL RESECTION

Abstract

Five patients with squamous or basaloid carcinoma of the anal canal were treated with synchronous chemotherapy and external radiotherapy. Three were operable cases, of which 1 had abdominoperineal resection subsequently, while 2 had no surgery. The other 2 had a locally advanced inoperable tumor in 1 case and pelvic recurrence following abdominoperineal resection in the other. The chemotherapy regimen consisted of mitomycin C given as a single dose of 10 mg m-2 at commencement of radiotherapy and 2 i.v. infusions of 5-fluorouracil 1000 mg m-2/day for 4 consecutive days .apprx. 4 wk apart. The radiation dose ranged from 50 Gy [grays] to 70 Gy in 25-35 fractions. All patients remain disease free with a median follow up of 14 mo. Eradication of tumor at the primary site was confirmed histologically in the 3 operable cases. A growing volume of data from the medical literature suggests that patients with operable carcinoma of the anal canal treated with this regimen have a probability of cure at least equal to that of abdominoperineal resection and have the advantage of retaining normal anal function and avoiding permanent colostomy.