THE SWEDISH NATIONAL CARE PROGRAM FOR ANAL CARCINOMA - IMPLEMENTATIONAND OVERALL RESULTS

The Swedish National Care Programme for Anal Carcinoma (SNCPAC) was in stituted in order to create a uniform handling policy for anal cancer and thus to accrue a population-based material allowing unbiased analy ses. This study evaluates the degree of implementation of the SNCPAC g uidelines, and presents overall treatment results in a total of 356 pa tients with epidermoid cancer of the anus and the perianal region diag nosed in Sweden between 1985 and 1989. Primary treatment according to the guidelines was irradiation up to 40 Gy. Bleomycin was administered intramuscularly before the first 18 fractions. After a 3-week pause, radiotherapy was to be continued up to a dose of 60-64 Gy, if at least an almost complete response was achieved. Otherwise, the patient was recommended surgery within a week. The guidelines were applied in 90% of cases where such treatment was possible. The 5-year tumour-specific survival rate was 72%. The survival rate was more favourable in peria nal rumours (90%) than in anal canal tumours (68%, p < 0.01). The 5-ye ar probability of having a preserved anus was 64% (anal canal/perianal 58%/91%, p < 0.001). Bleomycin did not appear to have any effect on t reatment results. The care programme has had a rapid and almost comple te nation-wide penetration, and h as created the desired uniformity al lowing proper analyses. The treatment results also appear comparable w ith specialised referral centres.