Abstract
Background: Up to one-third of patients with anal epidermoid cancer will fail initial chemoradiotherapy (CT-RT) or have local recurrence after treatment. This study evaluates the Memorial Sloan-Kettering Cancer Center (MSKCC) experience with salvage abdominoperineal resection (APR) in these patients.
Methods: Thirty-eight patients who underwent salvage APR following 5-fluorouracil (5-FU), mitomycin C, and radiotherapy over the past 12 years were analyzed by retrospective review. Survival was calculated by the Kaplan-Meier method and comparisons by log-rank analysis.
Results: The indications for APR were recurrent disease after CT-RT in 14 patients and persistent disease in 24 patients. Median follow-up time and survival were 47 and 41 months, respectively. The actuarial 5-year survival was 44%. Twenty-three patients had recurrent disease after APR. Inguinal lymphadenopathy at initial presentation (p<0.05), fixation of tumor to the pelvic sidewall (p<0.01), and pathologic involvement of the perirectal fat (p<0.01) adversely affected survival. Age, gender, initial response to CT-RT, initial stage of the primary tumor, histologic levator muscle involvement, status of perirectal lymph nodes, and extent of lymphadenectomy did not affect survival.
Conclusions: Salvage APR can be expected to yield a moderate number of long-term survivors, but the high rate of disseminated failure suggests the need for additional postoperative treatment.
Similar content being viewed by others
References
Nigro ND. The force of change in the management of squamous-cell cancer of the anal canal.Dis Colon Rectum 1991;34:482–6.
Nigro ND, Vaitkevicius VK, Considine B. Combined therapy for cancer of the anal canal: a preliminary report.Dis Colon Rectum 1974;17:354–6.
Leichman L, Nigro N, Vaitkevicius VK, et al. Cancer of the anal canal: model for preoperative adjuvant combined modality therapy.Am J Med 1985;78:211–5.
Papillon J. Effectiveness of combined radio-chemotherapy in the management of epidermoid carcinoma of the anal canal.Int J Radiat Oncol Biol Phys 1990;19:1217–8.
Flam MS, John MJ, Mowry PA, Lovalvo LJ, Ramalho LD, Wade J. Definitive combined modality therapy of carcinoma of the anus: a report of 30 cases including results of salvage therapy in patients with residual disease.Dis Colon Rectum 1987;30:495–502.
Meeker WRJ, Sickle Santanello BJ, Philpott G, et al. Combined chemotherapy, radiation, and surgery for epithelial cancer of the anal canal.Cancer 1986;57:525–9.
Newman HK, Quan SHQ. Multi-modality therapy for epidermoid carcinoma of the anus.Cancer 1976;37:12–9.
Quan SHQ, Magill GB, Leaming RH, Hajdu SI. Multidisciplinary preoperative approach to the management of epidermoid carcinoma of the anus and anorectum.Dis Colon Rectum 1978;21:89–91.
Habr Gama A, da Silva SJ, Nadalin W, Gansl R, da Silva JH, Pinotti HW. Epidermoid carcinoma of the anal canal: results of treatment by combined chemotherapy and radiation therapy.Dis Colon Rectum 1989;32:773–7.
Sischy B, Doggett RL, Krall JM, et al. Definitive irradiation and chemotherapy for radiosensitization in management of anal carcinoma: interim report on Radiation Therapy Oncology Group study no. 8314.J Natl Cancer Inst 1989;81:850–6.
Cummings BJ, Keane TJ, O'Sullivan B, Wong CS, Catton CN. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin c.Int J Radiat Oncol Biol Phys 1991;21:1115–25.
Cummings BJ. Anal cancer.Int J Radiat Oncol Biol Phys 1990;19:1309–15.
Leichman LP, Cummings BJ. Anal carcinoma.Curr Probl Cancer 1990;14:117–59.
Zelnick RS, Haas PA, Ajlouni M, Szilagyi E, Fox TAJ. Results of abdominoperineal resections for failures after combination chemotherapy and radiation therapy for anal canal cancers.Dis Colon Rectum 1992;35:574–78.
Greenall MJ, Magill GB, Quan SH, DeCosse JJ. Recurrent epidermoid cancer of the anus.Cancer 1986;57:1437–41.
Michaelson RA, Magill GB, Quan SH, Leaming RH, Nikrui M, Stearns MW. Preoperative chemotherapy and radiation therapy in the management of anal epidermoid carcinoma.Cancer 1986;51:390–5.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations.J Am Statist Assoc 1958;53:457–81.
Beahrs OH, Henson DE, Hutter RV, Myers MH.Manual for staging of cancer. Philadelphia: J.B. Lippincott Company, 1988.
Rothenberger DA, Wong WD. Abdominoperineal resection for adenocarcinoma of the low rectum.World J Surg 1992;16:478–85.
Stearns MW Jr., Quan SH. Epidermoid carcinoma of the anorectum.Surg Gynecol Obstet 1970;131:953–7.
Stearns MW, Urmacher C, Sternberg SS, Woodruff J, Attiyeh F. Cancer of the anal canal.Curr Probl Cancer 1980;4:1–44.
Quan SH. Anal cancers: squamous and melanoma.Cancer 1992;70:1384–9.
Cummings BJ. Concomitant radiotherapy and chemotherapy for anal cancer.Semin Oncol 1992;19(11):102–8.
Nigro ND. Multidisciplinary management of cancer of the anus.World J Surg 1987;11:446–51.
Gordon PH. Squamous-cell carcinoma of the anal canal.Surg Clin North Am 1988;68:1391–9.
Magill GB, Quan SH. Salvage chemotherapy of anal epidermoid carcinoma (AEC) with cisplatin (CP)-based protocols [Abstract].Proc Annu Meet Am Soc Clin Oncol 1989;8:A456.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ellenhorn, J.D.I., Enker, W.E. & Quan, S.H.Q. Salvage abdominoperineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus. Annals of Surgical Oncology 1, 105–110 (1994). https://doi.org/10.1007/BF02303552
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02303552