CURRENT TREATMENT OF CANCERS OF THE ANAL- CANAL

The major development in the treatment of cancers of the anal canal, o ver recent years, is the now predominant role of radiotherapy which ha s replaced amputation surgery as first-line treatment. All stages comb ined, the average 5-year global survival rate is now 60%, with a local control rate of 70% and good sphincter preservation in the majority o f healed patients. However, many questions remain unresolved in these rare cancers: what is the optimal irradiation technique, what is the r ole of chemotherapy in this very chemosensitive tumour but associated with a low risk of metastases ? Amputation surgery still plays an impo rtant role, but the exact time at which it should be proposed remains controversial. The rate of inguinal lymph node invasion is approximate ly 20%. The value of systematic treatment N0 inguinal nodes remains co ntroversial. As for most problems of clinical oncology, only randomize d trials rapidly conducted on a large scale will be able to provide an answer to all these questions.