The evolving treatment of anal cancer - How are we doing?

Hypothesis: The adaptation of new techniques in treatment of epidermoid car cinoma of the anal canal during the past 3 decades has improved clinical ou tcomes. Design: Retrospective consecutive case review Setting: A university hospital and Veterans Affairs medical center. Patients: Medical records of 76 consecutive patients treated for invasive e pidermoid cancer of the anal canal between 1970 and 1999 were reviewed. Twe nty-one patients were excluded because of inadequate staging information an d/or follow-up of less than 12 months. Main Outcome Measures: Locoregional recurrence, survival, colostomy-free su rvival, and morbidity. Results: Fifty-five patients composed the study population. Ten were treate d during decade 1 (1970-1979), 16 in decade 2 (1980-1989), and 29 in decade 3 (1990-1999). Mean age and sex distributions were similar. Thr prevailing primary treatment modality changed during the course of the study from seq uential treatment (chemotherapy then radiation therapy thin radical surgery ) to concurrent chemoradiation (70o% and 0% of cases, respectively, in deca de 1 to 7%, and 76%, of cases, respectively, in decade 3). Locoregional con trol (50%, 81%, and 93%; P=.01), crude survival (median, 28, 30, and 76 mon ths), and colostomy-free survival (mean, 13, 90, and 80 months) improved du ring the 3 decades. There were nu differences in major complications during the 3 decades (40%, 56%, and 41%). Conclusion: Primary treatment with concurrent chemoradiation has improved t he local recurrence, survival, and colostomy-free survival rates in patient s with invasive epidermoid carcinoma of the anal canal without increasing m ajor morbidity.