Feasibility of non-surgical definitive management of anal canal carcinoma.

The management of anal canal carcinoma has evolved over the last decade, with the combination of radiotherapy (RT) and chemotherapy (CT) offering a definitive alternative to surgery or RT alone. Twenty-two patients with basaloid/cloacogenic/squamous cell carcinoma of the anal (13 with T3-T4 lesions), were treated with synchronous RT (30.00 to 45.00 Gy in 3 1/2 to 5 weeks) and CT X 2 courses (Mitomycin C 15 mg/m2 I.V. bolus + 96 hours 5FU infusion). This regimen differed from the conventional Nigro regimen in that higher doses of RT and 2 courses of Mitomycin C were used and both CT courses were given synchronously with RT. Three patients with residual disease were salvaged with an additional course of CT and local RT, without surgery. Acute side effects including perineal dermatitis, diarrhea, leukopenia, and thrombocytopenia were reversible or transient. Twenty patients are alive and free of disease 17 to 62 months (median 45 months) following initiation of treatment. Two patients died at 7 months without evidence of disease at autopsy. These results compare favorably with other series employing RT alone, AP resection alone, and to those employing similar CT-RT regimens as well, in terms of disease-free survival rate (100%), complete response rate (19/22 or 86%), salvage rate without surgery (3/3), and acceptable morbidity. These results may be attributed to an optimal balance of RT and CT doses and refinements in RT technique which are detailed in our report.