While a combined resection of rectal cancer and partial hepatectomy are well established, the same is not the case for anal cancer. Metastatic anal cancer is not well studied in regard to combined resection. NCCN recommends only 5FU and cisplatin or cisplatin for metastatic anal cancer. A recent review states: ” Metastatic disease develops in 10%–17% of patients treated with chemoradiation therapy. The most common site of distant metastasis is the liver. There are limited published data on the use of chemotherapy, particularly newer agents, to treat metastatic anal carcinoma. Active agents include cisplatin plus 5-FU, carboplatin, doxorubicin, and semustine. Participation in a clinical trial should be discussed with all potentially eligible patients.”
Although there have been no randomized trials comparing surgery with radiation treatment or with combined chemoradiation, based on multiple studies and clinical experience for the last 20 years, there has been a substantial change in the management of epidermoid anal carcinomas, with more patients undergoing nonsurgical treatment.
I was not able to find credible literature supporting a combined resection approach for anal cancer. NCCN lists only 5 Fu and cisplatin for metastatic anal cancer therapy. The first report of this approach was by Tokar in 2006.
Principles and Practice of Gastrointestinal Oncology (Hardcover) by David P Kelsen (Editor), John M Daly (Editor), Scott E Kern (Editor), Bernard Levin Editor), Joel E Tepper (Editor) Publisher: Lippincott Williams & Wilkins; Second Edition edition (October 1, 2007), p.648 ISBN-13: 978-0781776172
NCCN.ORG, Anal Cancer 2012
Uronis, Hope E. , Bendell, Johanna C. Anal Cancer: An Overview Oncologist 2007 12: 524-534
Tokar M, Bobilev D, Zalmanov S, Geffen DB, Walfisch S. Combined multimodal approach to the treatment of metastatic anal carcinoma: report of a case and review of the literature. Onkologie. 2006 Feb;29(1-2):30-2.
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