TREATMENT OF ANAL CANCER

The primary noninvasive treatment of anal carcinoma by simultaneous ra dio-chemotherapy is generally accepted, although prospective randomize d studies have not been finished yet. The predominantly used cytotoxic agents are 5-fluorouracil and mitomycin C. Further optimizing improve ment to tumor response might depend on developing more effective sched ules of chemotherapy. Much is to be expected of treatment with cisplat in. Quality criteria for total- and single-dosage radiotherapy are wel l established in spite of different techniques. Brachytherapy requires special experience. Prophylactic radiation of the inguinal lymphatic pathways is widely used for all anal canal carcinomas as well as for a nal margin carcinomas, except for T1-carcinomas with superficial infil tration. Because of slow tumor regression, restaging should be done 3 months after completion of radio-chemotherapy. The need for control bi opsy is discussed more and more controversially and greater importance is given to clinical reevaluation. In case of good tumor regression w ith only minimal microscopical residual tumor load, local boost radiat ion should be applied. If tumor regression is insufficient, however, a bdomino-perineal resection must be performed. Anal margin carcinomas r equire according to their histopathologic type and tumor stage - a dif ferentiated therapy combining surgery and radio-chemotherapy,