CARCINOMA OF THE ANUS TREATED WITH PRIMARY RADIATION-THERAPY AND CHEMOTHERAPY

Between 1983 to 1989, 24 patients with previously untreated carcinoma of the anal canal (less than 3 centimeters in five patients and more t han 3 centimeters in 19 patients) were entered in a prospective nonran domized protocol of primary radiotherapy (4,050-4,500 cGy days one to 28) and chemotherapy (10 milligrams per meter squared of mitomycin C, on day two and 1,000 milligrams of 5-fluorouracil per molar squared fo r days two to five and 28 to 32). Therapy was discontinued for two pat ients because of severe (grade 4) skin reactions. The remaining patien ts tolerated the regimen well, with the exception of two patients who had grade 3 hematologic toxicity and three patients with grade 3 to 4 complications of the gastrointestinal tract. All of the patients who c ompleted the regimen had a complete clinical and pathologic response w hen restaged six weeks after completion of therapy. All patients with lesions of less than 3 centimeters and 13 of 19 patients with lesions greater than 3 centimeters have remained free of disease (median follo w-up period of 41 months; median survival rate of 36 months). Before 1 983, 19 patients underwent abdominal perineal resection as primary tre atment for carcinoma of the anus. Only six of seven patients with lesi ons less than 3 centimeters and zero of the 12 patients with lesions e qual or greater than 3 centimeters have remained alive and free of dis ease. Eighteen of 24 patients treated with chemotherapy and radiothera py only have remained free of disease and have preserved anal function . These results are superior to those reported with primary surgical t reatment and primary radiotherapy only.