Skip to main content
Erschienen in:

01.09.2005 | Original Contribution

Tumor Site Predicts Outcome After Radiochemotherapy in Squamous-Cell Carcinoma of the Anal Region: Long-Term Results of 101 Patients

verfasst von: Gerhard G. Grabenbauer, M.D., Hermann Kessler, M.D., Klaus E. Matzel, M.D., Rolf Sauer, M.D., Werner Hohenberger, M.D., Ignaz H. F. Schneider, M.D.

Erschienen in: Diseases of the Colon & Rectum | Ausgabe 9/2005

Einloggen, um Zugang zu erhalten

PURPOSE

This study was designed to assess the long-term results following radiochemotherapy in patients with anal squamous-cell carcinoma and to evaluate the impact of tumor location on response, survival, and colostomy-free survival.

PATIENTS AND METHODS

Between 1985 and 2001, a total of 101 patients with anal carcinoma were registered for curative treatment, of whom 77 had involvement of the anal canal alone, 10 cases had extension into the perianal skin, and 14 patients had pure anal margin tumors. Small tumors of the anal margin were not included since they were treated by surgical excision only. Among the 101 patients were 74 women and 27 men with a median age of 62 (range, 26–84) years. T categories (International Union against Cancer) were T1 (15), T2 (36), T3 (34), and T4 (16). Seventy-one patients had no evidence of nodal disease, whereas 30 presented with involved regional nodes. Radiation treatment was directed to the primary tumor region and to the inguinal, perirectal, and internal iliac nodes using a three-field to four-field box technique with 10MV photons up to a total dose of 5040 cGy. Lesions greater than 5 cm received an additional boost by interstitial or external radiation depending on circumferential extension of the residual tumor. All patients were scheduled for simultaneous chemotherapy with two cycles of 5-fluorouracil at a dose of 1000 mg/m 2/day as 120 hours of continuous intravenous infusion on Days 1 to 5 and 29 to 33 and mitomycin C at 10 mg/m 2/day on Days 1 and 29. Median follow-up time was was 7.5 (range, 1–16) years.

RESULTS

Overall survival and colostomy-free survival rates for patients with anal canal cancer were 75 percent and 87 percent at five years, respectively. Patients with anal margin cancer had a less favorable outcome with five-year-overall and colostomy-free survival rates of 54 percent and 69 percent, respectively. After correction for imbalance between anal canal and anal margin tumors, i.e., exclusion of T1 tumors of the anal canal, difference in overall survival remained significant (73 percent vs. 54 percent, P = 0.01). Following multivariate analysis, tumor location (anal canal vs. anal margin, P = 0.02), age (P = 0.003), and dose intensity of chemotherapy (≤75 percent vs. >75 percent, P = 0.03) remained independent significant factors for overall survival. Initial tumor response at six weeks (P = 0.03) was predictive for colostomy-free survival.

CONCLUSIONS

With colostomy-free survival rates around 85 percent, long-term treatment results for anal canal carcinoma have reached a satisfactory level. However, patients with larger lesions of the perianal skin are at high risk for locoregional recurrence and possible treatment intensification in this subgroup seems desirable.
Literatur
1.
Zurück zum Zitat Allal, A, Kurtz, JM, Pipard, G, et al. 1993Chemoradiotherapy versus radiotherapy alone for anal cancer: a retrospective comparisonInt J Radiat Oncol Biol Phys275966PubMed Allal, A, Kurtz, JM, Pipard, G,  et al. 1993Chemoradiotherapy versus radiotherapy alone for anal cancer: a retrospective comparisonInt J Radiat Oncol Biol Phys275966PubMed
2.
Zurück zum Zitat Eschwege, F, Laser, P, Chavy, A, et al. 1985Squamous cell carcinoma of the anal canal: treatment by external beam irradiationRadiother Oncol314550PubMed Eschwege, F, Laser, P, Chavy, A,  et al. 1985Squamous cell carcinoma of the anal canal: treatment by external beam irradiationRadiother Oncol314550PubMed
3.
Zurück zum Zitat Papillon, J 1974Radiation therapy in the management of epidermoid carcinoma of the anal regionDis Colon Rectum171847 Papillon, J 1974Radiation therapy in the management of epidermoid carcinoma of the anal regionDis Colon Rectum171847
4.
Zurück zum Zitat Papillon, J, Montbaron, JF 1987Epidermoid carcinoma of the anal canal. A series of 276 casesDis Colon Rectum532433 Papillon, J, Montbaron, JF 1987Epidermoid carcinoma of the anal canal. A series of 276 casesDis Colon Rectum532433
5.
Zurück zum Zitat Peiffert, D, Bey, P, Pernot, M, et al. 1997Conservative treatment by irradiation of epidermoid carcinomas of the anal marginInt J Radiat Oncol Biol Phys395766CrossRefPubMed Peiffert, D, Bey, P, Pernot, M,  et al. 1997Conservative treatment by irradiation of epidermoid carcinomas of the anal marginInt J Radiat Oncol Biol Phys395766CrossRefPubMed
6.
Zurück zum Zitat Schlienger, M, Krzisch, C, Pene, F, et al. 1989Epidermoid carcinoma of the anal canal: treatment results and prognostic variables in a series of 242 casesInt J Radiat Oncol Biol Phys17114151PubMed Schlienger, M, Krzisch, C, Pene, F,  et al. 1989Epidermoid carcinoma of the anal canal: treatment results and prognostic variables in a series of 242 casesInt J Radiat Oncol Biol Phys17114151PubMed
7.
Zurück zum Zitat Wagner, JP, Mahe, MA, Romestaing, P, et al. 1994Radiation therapy in the conservative treatment of carcinoma of the anal canalInt J Radiat Oncol Biol Phys291723PubMed Wagner, JP, Mahe, MA, Romestaing, P,  et al. 1994Radiation therapy in the conservative treatment of carcinoma of the anal canalInt J Radiat Oncol Biol Phys291723PubMed
8.
Zurück zum Zitat Nigro, ND, Vaitkevicius, VK, Considine, B 1974Combined therapy for cancer of the anal canalDis Colon Rectum277636 Nigro, ND, Vaitkevicius, VK, Considine, B 1974Combined therapy for cancer of the anal canalDis Colon Rectum277636
9.
Zurück zum Zitat Cummings, BJ, Keane, TJ, O’Sullivan, B, Wong, CS, Catton, CN 1991Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin CInt J Radiat Oncol Biol Phys21111525PubMed Cummings, BJ, Keane, TJ, O’Sullivan, B, Wong, CS, Catton, CN 1991Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin CInt J Radiat Oncol Biol Phys21111525PubMed
10.
Zurück zum Zitat Grabenbauer, GG, Wolf, N, Dunst, J, Sauer, R 1989Analkanalkarzinom: diagnostik-therapie-prognoseStrahlenther Onkol16582936PubMed Grabenbauer, GG, Wolf, N, Dunst, J, Sauer, R 1989Analkanalkarzinom: diagnostik-therapie-prognoseStrahlenther Onkol16582936PubMed
11.
Zurück zum Zitat Grabenbauer, GG, Schneider, IH, Gall, FP, Sauer, R 1993Epidermoid carcinoma of the anal canal: treatment by combined radiation and chemotherapyRadiother Oncol275962CrossRefPubMed Grabenbauer, GG, Schneider, IH, Gall, FP, Sauer, R 1993Epidermoid carcinoma of the anal canal: treatment by combined radiation and chemotherapyRadiother Oncol275962CrossRefPubMed
12.
Zurück zum Zitat Grabenbauer, GG, Panzer, M, Hültenschmidt, B, et al. 1997Combined radiation and chemotherapy for squamous cell carcinoma of the anal canal: results and prognostic variables in a multiinstitutional series of 173 patientsRadiol Oncol3121927 Grabenbauer, GG, Panzer, M, Hültenschmidt, B,  et al. 1997Combined radiation and chemotherapy for squamous cell carcinoma of the anal canal: results and prognostic variables in a multiinstitutional series of 173 patientsRadiol Oncol3121927
13.
Zurück zum Zitat Bartelink, H, Roelofsen, F, Eschwege, F, et al. 1997Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organisation for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative GroupsJ Clin Oncol1520409PubMed Bartelink, H, Roelofsen, F, Eschwege, F,  et al. 1997Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organisation for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative GroupsJ Clin Oncol1520409PubMed
14.
Zurück zum Zitat UKCCCR Anal Canal Cancer Working Party1996Epidermoid anal cancer: results from the UKCCCR randomized trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycinLancet348104954 UKCCCR Anal Canal Cancer Working Party1996Epidermoid anal cancer: results from the UKCCCR randomized trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycinLancet348104954
15.
Zurück zum Zitat Flam, MS, John, M, Pajak, T, et al. 1996Role of mitomycin C in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup studyJ Clin Oncol14252739PubMed Flam, MS, John, M, Pajak, T,  et al. 1996Role of mitomycin C in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup studyJ Clin Oncol14252739PubMed
16.
Zurück zum Zitat Hermanek P, Scheibe O, Spiessl B, Wagner G. UICC—TNM-klassifikation maligner tumoren. Berlin: Springer, 1992 Hermanek P, Scheibe O, Spiessl B, Wagner G. UICC—TNM-klassifikation maligner tumoren. Berlin: Springer, 1992
17.
Zurück zum Zitat World Health Organization. International classification of diseases for oncology. Geneva: WHO, 1990 World Health Organization. International classification of diseases for oncology. Geneva: WHO, 1990
18.
Zurück zum Zitat Klimpfinger, M, Hauser, H, Berger, A, Hermanek, P 1994Aktuelle klinisch-pathologische Klassifikation von Karzinomen des AnalkanalsActa Chir Austriaca2634551 Klimpfinger, M, Hauser, H, Berger, A, Hermanek, P 1994Aktuelle klinisch-pathologische Klassifikation von Karzinomen des AnalkanalsActa Chir Austriaca2634551
19.
Zurück zum Zitat World Health Organization. Handbook for reporting of cancer treatment. WHO offset publication no. 48. Geneva: WHO, 1979 World Health Organization. Handbook for reporting of cancer treatment. WHO offset publication no. 48. Geneva: WHO, 1979
20.
Zurück zum Zitat LENT-SOMA tables1995Table of contentsRadiother Oncol351760 LENT-SOMA tables1995Table of contentsRadiother Oncol351760
21.
Zurück zum Zitat Kaplan, EL, Meier, P 1958Non parametric estimation from incomplete observationsJ Am Stat Assoc5345781 Kaplan, EL, Meier, P 1958Non parametric estimation from incomplete observationsJ Am Stat Assoc5345781
23.
Zurück zum Zitat Cox, DR 1972Regression models and life tablesJ R Stat SocB34187202 Cox, DR 1972Regression models and life tablesJ R Stat SocB34187202
24.
Zurück zum Zitat Sischy, B 1985The use of radiation therapy combined with chemotherapy in the management of squamous cell carcinoma of the anusInt J Radiat Oncol Biol Phys11158793PubMed Sischy, B 1985The use of radiation therapy combined with chemotherapy in the management of squamous cell carcinoma of the anusInt J Radiat Oncol Biol Phys11158793PubMed
25.
Zurück zum Zitat Doci, R, Zucali, R, Monica, G, et al. 1996Primary chemoradiation therapy with fluorouracil and cisplatin for cancer of the anus: results in 35 consecutive patientsJ Clin Oncol1431215PubMed Doci, R, Zucali, R, Monica, G,  et al. 1996Primary chemoradiation therapy with fluorouracil and cisplatin for cancer of the anus: results in 35 consecutive patientsJ Clin Oncol1431215PubMed
26.
Zurück zum Zitat Gerard, JP, Ayzac, L, Hun, D, et al. 1998Treatment of anal canal carcinoma with high dose radiation therapy and concomitant fluorouracil-cisplatinum. Long-term results in 95 patientsRadiother Oncol4624956CrossRefPubMed Gerard, JP, Ayzac, L, Hun, D,  et al. 1998Treatment of anal canal carcinoma with high dose radiation therapy and concomitant fluorouracil-cisplatinum. Long-term results in 95 patientsRadiother Oncol4624956CrossRefPubMed
27.
Zurück zum Zitat Peiffert, D, Giovannini, M, Ducreux, M, et al. 2001High-dose radiation therapy and neoadjuvant plus concomitant chemotherapy with 5-fluorouracil and cisplatin in patients with locally advanced squamous-cell anal canal cancer: final results of a phase II studyAnn Oncol12397404CrossRefPubMed Peiffert, D, Giovannini, M, Ducreux, M,  et al. 2001High-dose radiation therapy and neoadjuvant plus concomitant chemotherapy with 5-fluorouracil and cisplatin in patients with locally advanced squamous-cell anal canal cancer: final results of a phase II studyAnn Oncol12397404CrossRefPubMed
28.
Zurück zum Zitat Weber, DC, Kurtz, JM, Allal, AS 2001The impact of gap duration in anal canal carcinoma treated by split-course radiotherapy and concomitant chemotherapyInt J Radiat Oncol Biol Phys5067580CrossRefPubMed Weber, DC, Kurtz, JM, Allal, AS 2001The impact of gap duration in anal canal carcinoma treated by split-course radiotherapy and concomitant chemotherapyInt J Radiat Oncol Biol Phys5067580CrossRefPubMed
29.
Zurück zum Zitat Papillon, J, Chassard, JL 1992Respective roles of radiotherapy and surgery in the management of epidermoid carcinoma of the anal margin. Series of 57 patientsDis Colon Rectum354229CrossRefPubMed Papillon, J, Chassard, JL 1992Respective roles of radiotherapy and surgery in the management of epidermoid carcinoma of the anal margin. Series of 57 patientsDis Colon Rectum354229CrossRefPubMed
30.
Zurück zum Zitat Cutuli, B, Fenton, J, Labib, A, Bataini, JP, Mathieu, G 1988Anal margin carcinoma: 21 cases treated at the Institute Curie by exclusive conservative radiotherapyRadiother Oncol1116CrossRefPubMed Cutuli, B, Fenton, J, Labib, A, Bataini, JP, Mathieu, G 1988Anal margin carcinoma: 21 cases treated at the Institute Curie by exclusive conservative radiotherapyRadiother Oncol1116CrossRefPubMed
31.
Zurück zum Zitat Bieri, S, Allal, AS, Kurtz, JM 2001Sphincter-conserving treatment of carcinomas of the anal marginActa Oncol402933CrossRefPubMed Bieri, S, Allal, AS, Kurtz, JM 2001Sphincter-conserving treatment of carcinomas of the anal marginActa Oncol402933CrossRefPubMed
32.
Zurück zum Zitat Grabenbauer, GG, Matzel, KE, Schneider, IH, et al. 1998Sphincter preservation with chemoradiation in anal canal carcinoma - abdominoperineal resection in selected cases?Dis Colon Rectum4144150PubMed Grabenbauer, GG, Matzel, KE, Schneider, IH,  et al. 1998Sphincter preservation with chemoradiation in anal canal carcinoma - abdominoperineal resection in selected cases?Dis Colon Rectum4144150PubMed
33.
Zurück zum Zitat Bosset, JF, Roelofsen, F, Morgan, DA, et al. 2003Shortened irradiation scheme, continuous infusion of 5-fluorouracil and fractionation of mitomycin C in locally advanced anal carcinomas. Results of a phase II study of the European Organisation for Research and Treatment of Cancer. Radiotherapy and Gastrointestinal Cooperative GroupsEur J Cancer394551CrossRefPubMed Bosset, JF, Roelofsen, F, Morgan, DA,  et al. 2003Shortened irradiation scheme, continuous infusion of 5-fluorouracil and fractionation of mitomycin C in locally advanced anal carcinomas. Results of a phase II study of the European Organisation for Research and Treatment of Cancer. Radiotherapy and Gastrointestinal Cooperative GroupsEur J Cancer394551CrossRefPubMed
34.
Zurück zum Zitat Allal, AS, Sprangers, MA, Laurencet, F, et al. 1999Assessment of long-term quality of life in patients with anal carcinomas treated by radiotherapy with or without chemotherapyBr J Cancer80158894PubMed Allal, AS, Sprangers, MA, Laurencet, F,  et al. 1999Assessment of long-term quality of life in patients with anal carcinomas treated by radiotherapy with or without chemotherapyBr J Cancer80158894PubMed
35.
Zurück zum Zitat Vordermark, D, Sailer, M, Flentje, M, Thiede, A, Kölbl, O 1999Curative-intent radiation therapy in anal carcinoma: quality of life and sphincter functionRadiother Oncol5223943CrossRefPubMed Vordermark, D, Sailer, M, Flentje, M, Thiede, A, Kölbl, O 1999Curative-intent radiation therapy in anal carcinoma: quality of life and sphincter functionRadiother Oncol5223943CrossRefPubMed
36.
Zurück zum Zitat Akbari, RP, Paty, PB, Guillem, JG, et al. 2004Oncologic outcomes of salvage surgery for epidermoid carcinoma of the anus initially managed with combined modality therapyDis Colon Rectum47113644CrossRefPubMed Akbari, RP, Paty, PB, Guillem, JG,  et al. 2004Oncologic outcomes of salvage surgery for epidermoid carcinoma of the anus initially managed with combined modality therapyDis Colon Rectum47113644CrossRefPubMed
37.
Zurück zum Zitat Ghouti, L, Houvenaeghel, G, Moutardier, V, et al. 2005Salvage abdominoperineal resection after failure of conservative treatment in anal epidermoid cancerDis Colon Rectum481622CrossRefPubMed Ghouti, L, Houvenaeghel, G, Moutardier, V,  et al. 2005Salvage abdominoperineal resection after failure of conservative treatment in anal epidermoid cancerDis Colon Rectum481622CrossRefPubMed
38.
Zurück zum Zitat Perara, D, Pathma-Nathan, N, Rabbitt, P, et al. 2003Sentinel node biopsy for squamous-cell carcinoma of the anus and anal marginDis Colon Rectum4610279CrossRefPubMed Perara, D, Pathma-Nathan, N, Rabbitt, P,  et al. 2003Sentinel node biopsy for squamous-cell carcinoma of the anus and anal marginDis Colon Rectum4610279CrossRefPubMed
Metadaten
Titel
Tumor Site Predicts Outcome After Radiochemotherapy in Squamous-Cell Carcinoma of the Anal Region: Long-Term Results of 101 Patients
verfasst von
Gerhard G. Grabenbauer, M.D.
Hermann Kessler, M.D.
Klaus E. Matzel, M.D.
Rolf Sauer, M.D.
Werner Hohenberger, M.D.
Ignaz H. F. Schneider, M.D.
Publikationsdatum
01.09.2005
Erschienen in
Diseases of the Colon & Rectum / Ausgabe 9/2005
Print ISSN: 0012-3706
Elektronische ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-005-0098-5

Weitere Artikel der Ausgabe 9/2005

Diseases of the Colon & Rectum 9/2005 Zur Ausgabe

Letter to the Editor

The Authors Reply

OriginalPaper

Announcements

Neu im Fachgebiet Chirurgie

Cold-Snare- kann Hot-Snare-Polypektomie kaum ersetzen

Bei der Abtragung größerer ungestielter Darmpolypen lohnt es sich, weiterhin der Hot-Snare-Technik zu vertrauen. Damit kommt es zwar etwas häufiger zu Komplikationen, dafür wesentlich seltener zu endoskopischen Rezidiven.

Weißer Hautkrebs: Ein Update zu Diagnostik und Therapie

18.07.2024 Fortbildungswoche 2024 Kongressbericht

In der aktualisierten Version der S3-Leitlinie „Aktinische Keratose und Plattenepithelkarzinom der Haut“ gibt es neue Empfehlungen, unter anderem zu erweiterten Optionen bei aktinischer Keratose sowie zur systemischen und chirurgischen Behandlung von Plattenepithelkarzinomen. Ein Überblick.

Vier Kriterien sprechen für ein erhöhtes Risiko nach Appendektomie

17.07.2024 Appendektomie Nachrichten

Um bei Kindern den Schweregrad einer Appendizitis und drohende Komplikationen richtig einzuschätzen, können sich Chirurginnen und Chirurgen auf die intraoperativen Kriterien des US-amerikanischen NSQIP Pediatric stützen.

Partielle Nephrektomie: Videoanalysen zur Verbesserung der chirurgischen Qualität

16.07.2024 Nephrektomie Nachrichten

Je versierter Operateurinnen und Operateure sind, desto geringer ist das Risiko für Komplikationen. Eine kleine US-Studie spricht dafür, dass das auch bei Roboter-assistierten Nephrektomien gilt – und dass sich Op.-Videos für die Beurteilung eignen.        

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.