SPHINCTER PRESERVATION WITH CHEMORADIATION IN ANAL-CANAL CARCINOMA - ABDOMINOPERINEAL RESECTION IN SELECTED CASES

PURPOSE: This study contained herein assessed long-term results, toxic ity, and prognostic variables following combined modality therapy of p atients with International Union Against Cancer Classification T1-4, N O-3, MO squamous-cell carcinoma of the anal canal. PATIENTS AND METHOD S. Between 1985 and 1996, 62 patients completed treatment with combine d modality therapy. A median total dose of 50 Gy was given to the prim ary, perirectal, presacral, and inguinal nodes followed by a local boo st in selected cases. 5-Fluorouracil was scheduled as a continuous inf usion of 1,000 mg/m(2) per 24 hours on days 1 to 5 and 29 to 33 and mi tomycin C as a bolus of 10 mg/m(2) on days 1 and 23. Routinely process ed paraffin-embedded sections were stained using monoclonal antibodies for detection of proliferating cell nuclear antigen and MIBI (Ki-67) antigen to determine the labeling index. In addition, DNA ploidy was a ssessed after Feulgen staining. RESULTS: Actuarial cancer-related surv ival, no evidence of disease survival, and colostomy-free survival rat es at five years were 81, 76, and 86 percent, respectively. In univari ate analysis, T category (T1/2 vs. T3/4) was predictive for no evidenc e of disease survival (87 vs. 59 percent; P = 0.03) and colostomy-free survival (94 vs. 73 percent; P = 0.05). N category (NO vs. N1-3) infl uenced actuarial cancer-related survival (85 vs. 58 percent; P = 0.002 ) and no evidence of disease survival (80 vs. 53 percent; P = 0.02). A higher proliferative potential as measured by the MIB1 labeling index was associated with a better colostomy-free survival (90 vs. 50 perce nt; P = 0.04). In multivariate analysis, actuarial cancer-related surv ival was only influenced by the N category (P = 0.03) and no evidence of disease survival by N category (P = 0.03) and mitomycin C dose (P = 0.04). Salvage abdominoperineal resection achieved long-term control in only four of seven patients with local failures. CONCLUSION: Treatm ent with a combination of radiotherapy and chemotherapy is safe and ef fective for patients with anal canal carcinoma. Abdominoperineal resec tion is indicated as a salvage procedure in nonresponding and recurren t lesions and may be of benefit in a small subgroup of patients with p oor prognostic factors.