THE NATIONAL CANCER DATA-BASE REPORT ON CARCINOMA OF THE ANUS

BACKGROUND. The last 15 years have seen substantial advances in the ma nagement of anal carcinoma, primarily in the use of radiochemotherapy as definitive or adjuvant treatment. This study reviews the patterns o f presentation, care, and outcome reflected in data from the National Cancer Data Base representing a broad range of medical centers. METHOD S. Data on patients with anal carcinoma (on 1050 patients from 1988 an d 1289 patients from 1993) were reviewed for patterns of care and pres entation. The 1988 cases were also reviewed for outcome data. RESULTS. There was an increase in the use of chemotherapy between 1988 and 199 3 (from 61.6% to 67.2%), and substantial differences were observed in the management of epidermoid carcinomas and adenocarcinomas. The major ity of epidermoid carcinomas were managed nonsurgically, principally w ith combined chemotherapy and radiation, whereas three-fourths of pati ents with adenocarcinoma underwent surgery. The most important factors for favorable 5-year survival were early stage (ranging from 71.3% fo r Stage I to 23.1% for Stage IV), epidermoid carcinoma histology (57.6 %, compared with 41.3% for adenocarcinoma), and female gender (56.2%, compared with 49.6% for males). For Stage I-II epidermoid carcinomas, the 5-year survival for patients who received nonsurgical treatment wi th radiochemotherapy was equivalent to that of patients who received s urgical treatment (64.0% and 65.4%, respectively). CONCLUSIONS. This s tudy confirms a trend in patterns of care favoring nonsurgical managem ent with radiochemotherapy for epidermoid carcinomas of the anus. For adenocarcinomas, there has been a trend toward increasing use of multi modality therapy with surgery and adjuvant radiochemotherapy. Survival data from the 1988 cases confirmed the efficacy of conservative treat ment with radiation plus chemotherapy for epidermoid carcinomas. (C) 1 997 American Cancer Society.