Combined Modality Treatment of Anal Carcinoma.

Within the framework of two phase III clinical trials, the superior results of concomitant chemotherapy and radiotherapy in the treatment of patients with locally advanced anal carcinoma were demonstrated. A further phase III clinical trial showed that the role of mitomycin C as part of the concomitant chemotherapy in combination with 5-fluorouracil appeared to be essential in obtaining a higher local control rate. All three of these randomized trials have shown that this improved local control rate results in a reduction of the colostomy rate. The standard treatment for locally advanced anal carcinoma is therefore the concomitant use of chemotherapy and radiotherapy. Future issues to be clarified include a search for the optimal radiation dose and the use of less toxic agents. For smaller tumors, the addition of chemotherapy still has to be assessed.