Anal cancer is a rare clinical entity which represents 1–2% of all gastrointestinal tract cancers. Due to the paucity of this malignancy it has been difficult to establish generally accepted guidelines for treatment, although various therapy modalities have been evaluated. For a long time radical surgery was the primary treatment for anal cancer and still about 30% of the patients undergo abdominoperineal rectotomy. However, recurrence rates of 20–40% have been observed after this multilating procedure. Therefore, other treatment options, including external or interstitial radiotherapy and chemotherapy, are used increasingly with the intention to preserve sphincter function. In the last years much interest has been addressed to multimodal therapy with radiation (50 Gy) and chemotherapy (5 fluouracil and mitomycin C). Presently radiochemotherapy appears to be the most efficient therapy in advanced anal cancer. Locoregional tumor control is obtained in 60–80% of the patients and there is evidence that radiochemotherapy can improve disease-free survival. The combination of 5-FU/mitomycin-C and radiation has demonstrated durable rates of local control but no benefit to overall survival. In a trial from the European Organization for Research and Treatment of Cancer (EORTC), patients were randomized to receive radiotherapy alone (45 Gy over 5 weeks) or radiotherapy and chemotherapy with 5-FU/ mitomycin-C. Patients in the combined modality arm had decreased rates of local recurrence. Current recommendations for treatment are based on this EORTC trial. Giving 5 FU alone is reasonable in the elderly patients, based on phase II trials.
nccn.org, Anal cancer
N Charnley et al, Effective treatment of anal cancer in the elderly with low-dose chemoradiotherapy British Journal of Cancer (2005) 92, 1221-1225.
Dennis L. Rousseau et al, Overview of anal cancer for the surgeon Surgical Oncology Clinics of North America Volume 13, Issue 2, April 2004, Pages 249-262