Management of anal epidermoid carcinoma--an evaluation of treatment results in two population-based series.

Between 1978 and 1984, two unselected population-based groups of patients with anal epidermoid carcinoma were analysed: (1) a retrospective group (Stockholm region, 90 cases), where the treatment varied considerably (partly radiation therapy +/- chemotherapy +/- surgery, partly surgery alone), and (2) a prospective group (Uppsala region, 51 cases) mainly treated by primary irradiation +/- chemotherapy followed by surgery in some cases. At diagnosis, 106 of the patients were free from metastases. Two of these patients died before treatment began. Of the remaining 104 patients, 77 received primary radiotherapy +/- chemotherapy, 44 to a dose of 30-40 Gy and 33 to a higher dose level, 55-65 Gy. Radiotherapy was followed by surgery in 28 cases. Twenty-seven patients were operated on primarily. The projected 5-year survival rate was significantly higher in the Uppsala than in the Stockholm region (all patients: 55% versus 43%; patients with no initial dissemination: 75% versus 48%). The prognosis was better in patients initially treated with radiotherapy than in those initially treated with surgery. Long-term disease-free survival was 88% in patients treated with radiation alone to an adequate (high) dose level. Multivariate analyses indicated that besides stage and sex, initial treatment and region gave statistically significant prognostic information. There was no evidence that chemotherapy (Bleomycin) conferred any additional benefit. It is concluded that the initial treatment in anal carcinoma should be radiotherapy (+/- chemotherapy). In patients with no initial dissemination, this therapy seems to improve 5-year survival by 25-30% compared with primary surgery.