Improved survival in epidermoid carcinoma of the anus in association with preoperative multidisciplinary therapy
W. E. Enker, M. Heilwell, A. J. Janov, S. H. Quan, G. Magill, M. W. Stearns Jr, B. Shank, R. Leaming and S. S. Sternberg
From 1972 to 1983, we treated 78 patients who had primary epidermoid
carcinoma of the anus. Forty-four of these patients were treated by
protocol, while 34 patients were not treated according to protocol.
Protocol consisted of fluorouracil (750 mg/m for 5 days) and mitomycin (10
to 15 mg/m on day 1), followed sequentially by 3000 rad (30 Gy) over three
weeks, followed by surgery. There were 20 local excisions and 29
abdominoperineal resections in the protocol group, and 11 local excisions
and 14 abdominoperineal resections in the nonprotocol group. In the
protocol group, 26 patients (59%) had no residual cancer in their operative
specimens, while only ten (29.9%) of the nonprotocol patients had no
remaining cancer. Four (11.7%) of the 34 nonprotocol patients had
pathologically positive inguinal nodes, compared with only three (4.5%) of
44 protocol patients. Thirty-four (77%) of 44 protocol patients remained
free of disease, while ten patients experienced local or pelvic recurrence.
In contrast, only 17 (50%) of 34 patients in the nonprotocol group remained
free of disease. Of 17 recurrences, five were at distant sites. The status
at this writing of all patients in the protocol group was 32 (75%), with no
evidence of disease, four alive with disease, and eight dead of or with
disease. Of the untreated patients, only 11 (32%) remained without evidence
of disease, two were alive with disease, and 19 were dead of or with
disease. Smaller carcinoma size (less than 5 cm, 27 of 32 had no evidence
of disease), younger age, female gender, and deep infiltration also
predicted a statistically significant survival advantage after protocol
treatment. Controlled, prospective, multi-institutional trials should
stratify for these factors when comparing new treatment modalities.
