RADIOCHEMOTHERAPY WITH AND WITHOUT RADICA L SURGERY IN ANAL CARCINOMA- LONG-TERM RESULTS OF MUNICH-GROSSHADERN

Radiochemotherapy has replaced surgery in curative treatment of anal c arcinoma irrespective of local tumor stage. 50 consecutive cases of an al carcinoma T1-T4, admitted 1982-1988, are presented. All were treate d with radiochemotherapy consisting of Mitomycin (10 mg/m2 on day 1), 5-fluorouracil (1,000 mg/m2/24hrs on day 1-4) and radiotherapy of the primary tumor and the lymphatic pathways of the pelvis (40 Gy on day 2 -29). During the first years of the reported interval abdominoperineal exstirpation followed obligatorily (group 1, N = 20). Later on, resid ual tumor was boosted (group 2, N = 30) in order to avoid radical surg ery. In the first treatment group 5 and in the second group 8, local r elapses occurred (for T1/2 and T3/4 stages p = 0.51 and 0.62, no signi ficant difference; minimal observation time 50 months). Tumor-related 10-year-survival in group 1 (54%) and 2 (82%) also does not differ sig nificantly (p = 0.24). 3/4 salvage resections achieved permanent freed om of disease. Incontinence and intractable ulcerations lead to abdomi noperineal exstirpation in 2 or 4 patients respectively. When combined with an adequate boost method and salvage surgery reserved for recurr ence, the presented protocol of radiochemotherapy is as successful as in combination with radical surgery and preserves normal anal function in two thirds of patients. The results of comparable radiochemotherap y protocols in the literature are surveyed.