Effectiveness of surgical salvage therapy for patients with locally uncontrolled anal carcinoma after sphincter-conserving treatment

BACKGROUND. Locally persistent or recurrent anal carcinoma represents a cli nically significant problem, the management of which remains the subject of some controversy. Although the few current data suggest that radical surge ry remains the sole salvage treatment able to provide some chance of cure, some authors have reported disappointingly low success rates. The current s tudy presents the outcome of patients who failed locally after receiving ra diotherapy or chemoradiotherapy for anal carcinoma. METHODS. Of 185 consecutive patients treated between January 1976 and Decem ber 1996 with sphincter conservation, 42 subsequently presented with local failure, either alone (27 patients) or with regional or distant metastases (15 patients). Nine patients (21%) received supportive care only, 7 patient s (17%) received palliative therapy, and 26 patients (62%) underwent potent ially curative surgical salvage treatment, including 23 abdominoperineal re sections (APR) and 3 local excisions. The median follow-up after local fail ure for all patients was 21.5 months (range, 1-231 months). RESULTS. With the exception of 2 patients who committed suicide, all patien ts who did not undergo surgical salvage therapy died of progressive disease . Among 26 patients who received curative treatment, 11 ultimately achieved disease control. The 5 year overall survival rate after the diagnosis of l ocal failure was 28% for all patients and 44.5% for those receiving curativ e salvage treatment. For the latter group the 5-year actuarial secondary lo cal and locoregional control rates were 53% and 43%, respectively. CONCLUSIONS. Although APR no longer is the first-line treatment of patients with anal carcinoma, it continues to play an essential role in salvage the rapy, resulting in ultimate disease control in approximately 50% of patient s with isolated local failure. The curative potential of secondary surgical treatment suggests the possible importance of early detection of persisten t or recurrent local disease after nonsurgical, sphincter-conserving therap y. (C) 1999 American Cancer Society.