CONSERVATIVE TREATMENT BY IRRADIATION OF EPIDERMOID CARCINOMAS OF THEANAL MARGIN

Purpose: Few series have described treatment results of anal margin tu mors as defined in the UICC 87 classification. The purpose of this art icle is to describe experience with an uncommon condition in a single cancer center. Methods and Materials: From 1971 to 1995, 32 patients w ith carcinoma of the anal margin were irradiated with a curative inten t, and 31 were followed-up for more than 6 months (mean = 4.5 years). There were 9 T1, 15 T2, 7 T3, and 1 T4 (vulvar), with 26 NO and 6 N1. There was a minor invasion of the lower canal in 17 patients; The hist ological types mere 24 squamous cell and 7 basocellular carcinomas, an d 1 Paget's disease. The treatment was a combined External Beam Irradi ation (EBI) and Brachytherapy (BT) in 16 patients, an exclusive BT in 12 patients, and an exclusive EBI in 4 patients. No prophylactic ingui nal irradiation was delivered. Results: The 5-year actuarial results a re as follows: overall survival = 67%, specific survival = 89%. The on ly prognostic factor was nodal involvement (p < 0.001). T-stage, T-siz e, age, sex, and treatment schedule were not significant. The overall local control was 77%, and 93.5% after salvage. Two NO patients relaps ed in inguinal areas (one was salvaged). Twenty-six percent presented a Grade 3 or 4 late complication, necessitating a temporary colostomy in only one patient. The sphincter conservation reached 84% for the wh ole series, 80% for patients followed-up 5 years or more, and 89% for cured patients. Conclusion: Results are similar to other series, and s eem better than for anal canal cancer. We recommend exclusive irradiat ion. There is no data recommending concomitant chemotherapy. Depending on the tumor size and localization, the tumor boost can be applied by EBI or BT. Surgery is reserved for small tumors far from the canal or for salvage. An inguinal prophylactic bilateral irradiation should be recommended for NO, with tumors over 4 cm. (C) 1997 Elsevier Science Inc.