Treatment results in anal cancer: non-operative treatment versus operative treatment

This study was undertaken to analyze the efficacy and sphincter preservation rate of platinum based neoadjuvant chemotherapy plus radiotherapy versus abdominoperineal resection and postoperative radiotherapy for anal cancer. Data of forty-two patients with anal cancer were retrospectively analyzed. Among thirty-eight patients with epidermoid histology, four patients received radiotherapy, and nineteen patients received abdominoperineal resection and adjuvant radiotherapy with or without chemotherapy (APR + RT ± CT), and fifteen patients received neoadjuvant chemotherapy and radiotherapy (CRT). The CRT regimen was composed of three cycles of 5-fluorouracil (1,000 mg/m2 bolus on D1 ∼ 5) and cisplatin (60 mg/m2 bolus on D1) followed by 50.4 Gy to the tumor bed and regional lymphatics over 5.5 weeks. Both inguinal lymphatics were treated with an identical dose schedule. Residual disease was treated with an additional three cycles of identical adjuvant chemotherapy. An identical dose schedule was used for post-operative radiotherapy. Median follow-up period was eighty-five months. Overall five-year survival rates were 80.3%, 88.9% and 79.4% for entire patients, APR + RT ± CT group, and the CRT group, respectively. No significant difference was found between the two groups (ρ = 0.49). Anus preservation rate for the CRT group was 86.7%. Age (ρ = 0.0164) and performance status (ρ = 0.0007) were found to be significant prognostic factors by univariate analysis. Age (ρ = 0.0426), performance status (ρ = 0.0068), and inguinal lymph node metastasis (ρ = 0.0093) were statistically significant prognostic factors by multivariate analysis. No case of RTOG grade 3 complication or higher was reported. This and other recent studies have shown that combined chemotherapy plus radiotherapy for anal cancer results in a high rate of anal sphincter preservation as well as local control and survival. Furthermore, neoadjuvant use of chemotherapy with a cisplatin based regimen rather than a concurrent regimen may lead to a decrease in complications