Preoperative chemotherapy and radiation therapy in the management of anal epidermoid carcinoma

Authors

  • Richard A. Michaelson MD,

    1. Solid Tumor Service, Department of Medicine; Colorectal Service, Department of Surgery; and Department of Radiation Therapy, Memorial Sloan-Kettering Cancer Center, Cornell University School of Medicine, New York, New York
    Current affiliation:
    1. 120 Millburn Avenue, Millburn, NJ, 07041
    Search for more papers by this author
  • Gordon B. Magill MD,

    Corresponding author
    1. Solid Tumor Service, Department of Medicine; Colorectal Service, Department of Surgery; and Department of Radiation Therapy, Memorial Sloan-Kettering Cancer Center, Cornell University School of Medicine, New York, New York
    • Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021
    Search for more papers by this author
    • Associate Attending Physician, Solid Tumor Service.

  • Stuart H. Q. Quan MD,

    1. Solid Tumor Service, Department of Medicine; Colorectal Service, Department of Surgery; and Department of Radiation Therapy, Memorial Sloan-Kettering Cancer Center, Cornell University School of Medicine, New York, New York
    Search for more papers by this author
    • Attending Physician, Colorectal Service.

  • Robert H. Leaming MD,

    1. Solid Tumor Service, Department of Medicine; Colorectal Service, Department of Surgery; and Department of Radiation Therapy, Memorial Sloan-Kettering Cancer Center, Cornell University School of Medicine, New York, New York
    Search for more papers by this author
    • Associate Attending Physician, Department of Radiation Therapy.

  • Majomosama Nikrui MD,

    1. Solid Tumor Service, Department of Medicine; Colorectal Service, Department of Surgery; and Department of Radiation Therapy, Memorial Sloan-Kettering Cancer Center, Cornell University School of Medicine, New York, New York
    Current affiliation:
    1. Department of Gynecology, Massachusetts General Hospital, Fruit Street, Boston, Massachusetts 02114
    Search for more papers by this author
  • Maus W. Stearns MD

    1. Solid Tumor Service, Department of Medicine; Colorectal Service, Department of Surgery; and Department of Radiation Therapy, Memorial Sloan-Kettering Cancer Center, Cornell University School of Medicine, New York, New York
    Search for more papers by this author
    • Attending Surgeon, Colorectal Service.


Abstract

Management of epidermoid carcinoma of the anus has been primarily surgical in the past. Since it is a relatively rare entity, meaningful survival statistics are difficult to obtain. Five-year survival rates fall between 35 and 68% in patients treated with surgery and/or radiotherapy. Based on preliminary studies indicating promising results with the use of mitomycin C and 5-fluorouracil (5-FU) chemotherapy combined preoperatively with radiation therapy, these authors initiated a protocol in 1973 utilizing this multimodality approach. The preoperative treatment consisted of mitomycin C 15 mg/m2 IV bolus on day 1 and 5-FU 750 mg/m2/24 hours continuous infusion for five days. Radiation followed chemotherapy and consisted of 3000 rad given at 200 rad per day for 15 fractions. Of 37 patients entered on the protocol, 30 had primary disease and seven had been previously treated and had local recurrences. Median follow-up has been 28 months (range, 5-74 months). Of 31 patients with measurable lesions, 29 (94%) had major clinical responses (CR + PR) to the combined chemotherapy and radiation. Pathologic responses were also impressive with 53% (17/32) showing no evidence of residual tumor in the subsequently resected surgical specimen. Of the 37 patients treated, seven (19%) have had recurrences. The recurrence rate was 4/17 (24%) for those who had local excision following complete response to therapy as opposed to 3/18 (17%) for those treated by abdominoperineal resection. Thus it appears that the combination of preoperative mitomycin C and 5-FU with radiotherapy is effective at least in significantly downstaging this uncommon malignancy. Its ultimate effect on recurrence rate and overall patient survival awaits longer follow-up.

Ancillary