Overview of Treatment Options
Previously it was thought that abdominoperineal resection leading to permanent colostomy was required for all except small anal tumors located below the dentate line, treatment with which about 70% of patients survived five years or more in institutions, but such surgery is no longer the preferred treatment. Radiation therapy alone may lead to a survival rate five years in more than 70%, although high doses (6,000 cGy or more) may cause necrosis or fibrosis. Chemotherapy concurrent with low-dose radiation therapy have led to a survival rate five years more than 70% with low level of acute and chronic morbidity, and few patients require surgery due to the toxic effects dermal or sphincter. Still being evaluated the optimal dose of radiation concurrent with chemotherapy to optimize local control and minimize sphincter toxic effects, but appears to be between 45 and 60 Gy. The analysis of a test between groups that compared radiation therapy plus fluorouracil / mitomycin with radiation therapy plus fluorouracil alone in patients with anal cancer has shown better results by adding mitomycin (lower colostomy rates and longer survival and disease-free colostomy). Radiation with continuous infusion of fluorouracil plus cisplatin is also under evaluation. The standard salvage therapy for patients with residual disease, either gross or microscopic chemoradiotherapy was followed by abdominoperineal resection. Alternatively, patients may receive additional rescue chemoradiotherapy as fluorouracil, cisplatin, and a stronger dose of radiation to potentially avoid permanent colostomy.
Due to the small number of cases, you need more information can be obtained only through the participation of patients in well designed clinical trials to improve the management of anal cancer. Patients with stages II, III and IV should be considered candidates for clinical trials.
HIV and anal cancer
The tolerance exhibited by patients with human immunodeficiency virus (HIV) and anal carcinoma Standard chemoradiation with fluorouracil / mitomycin is not well defined. Patients with CD4 cell counts below 200 before treatment could experience more acute and late toxic effects, so it may be necessary to modify the doses of chemoradiation in this subset of patients.
The designations in PDQ that treatments are “standard” or “under clinical evaluation” are not to be relied upon to determine whether to grant refunds
Standard treatment options:
Surgical resection is used to treat perianal lesions not involving the anal sphincter (the focus of the operation will depend on location of the lesion in the anal canal).
CANCER OF THE YEAR – PHASE I
Anal cancer stage I was formerly treated with abdominoperineal resection. Current therapies in preserving the sphincter include wide local excision of the perianal skin or anal margin for small tumors, or definitive chemoradiation (fluorouracil and mitomycin) for cancers of the anal canal.
Salvage chemoradiation therapy (fluorouracil and cisplatin plus a radiation boost) may avoid permanent colostomy in patients with residual tumor after undergoing initial nonoperative therapy. Radical resection is reserved for patients with incomplete responses or recurrent disease. It is therefore important continuous surveillance with rectal examination every 3 months during first 2 years and endoscopy / biopsy when indicated after completion of therapy for sphincter preservation.
Standard treatment options:
1. Small tumors of the perianal skin or anal margin not
complicate the anal sphincter may be adequately treated with local resection.
2. Other types of anal canal cancer in stage I complicate
anal sphincter or are too large for complete local excision receive external beam radiation therapy with or without chemotherapy.
Chemotherapy with fluorouracil and mitomycin combined with primary radiation therapy appears more effective than radiotherapy alone. The optimal dose of radiation concurrent with chemotherapy is under clinical evaluation.
Selected tumors are also candidates to receive interstitial irradiation.
3. The Radical resection is reserved for the canal cancer
residual or recurrent anal after nonoperative therapy.
4. Alternately, salvage chemotherapy with fluorouracil and
cisplatin combined with radiation boost may avoid permanent colostomy in selected patients with small amounts of a residual tumor following initial nonoperative therapy.
5. The interstitial Iridium-192 after external beam radiation may
convert some patients with residual disease in patients who respond to treatment in a comprehensive manner