TREATMENT OF ANAL-CANAL CARCINOMA WITH HIGH-DOSE RADIATION-THERAPY AND CONCOMITANT FLUOROURACIL-CISPLATINUM - LONG-TERM RESULTS IN 95 PATIENTS

Purpose: To evaluate the long-term results of the treatment of anal ca nal carcinoma (ACC) with a combined concomitant radiochemotherapy (CCR T) treatment using fluorouracil (5 FU) and cisplatinum (CDDP) with a h igh dose of radiation therapy. Patients and methods: Between 1982 and 1993 a series of 95 patients were treated. Staging showed a majority o f advanced squamous ACC, i.e. 6 TI, 47 T2, 28 T3, 14 T4, 53 N0, 32 N1, 6 N2 and 4 N3. Irradiation was done with high dose external beam radi ation therapy (EBRT) followed by a boost with 192 Iridium implant. Dur ing EBRT all patients received one course of 5 FU continuous infusion (1 g/m(2)/day, days 1-4) and CDDP (25 mg/m(2)/day, bolus days 1-4). Re sults: The median follow-up time was 64 months. At 5 and 8 years the o verall survival was 84 and 77%, the cancer specific survival was 90 an d 86% and the colostomy-free survival was 71 and 67%, respectively. Th e stage and the response of the tumor after EBRT were of prognostic si gnificance. Patients with pararectal lymph nodes had an overall 5-year survival of 76% (versus 88% for non-N1). Among 78 patients who preser ved their anus, the anal sphincter function was excellent or good in 7 2 (92%). Conclusion: According to these results and recent randomized trials, CCRT appears as the standard treatment of ACC. Radical surgery should be reserved for local recurrence or persisting disease after i rradiation. High dose irradiation in a small volume with concomitant 5 FU-CDDP appears to give a high rate of long-term local control and su rvival. Careful evaluation of pararectal nodes is essential for a good staging of the disease. (C) 1998 Elsevier Science Ireland Ltd.