---Concurrent chemoradiotherapy---- Fluorouracil + mitomycin + XRT: This modality can "cure" 80% of patients with small tumors. 5-FU 1 g/m2/d IV CI DAYS 1-4 & DAYS 29-32 MITOMYCIN 15 mg/m2 IV on DAY 1 RADIATION 200 cGy/d x 5 days per wk total 3000 cGy A recent RTOG trial showed use of mitomycin with XRT & 5FU increased complete tumor regression & improved colostomy-free survival over XRT & 5FU alone. At 4 years, the colostomy-free survival rate was higher in the mitomycin arm than in the 5FU-alone arm (71% vs 59%) as was the disease-free survival rate (73% vs 51%) JCO 114:2527-2539, 1998 Am J Med 78:211-215, 1985 ___________________________________________ Fluorouracil + cisplatin + XRT 5FU 1 g/m2/d IV CI DAYS 1-4 CISPLATIN 25 mg/m2/d IV DAYS 2-5 Hydration before & after Cisplatin: 500 cc + mannitol + MgSO4+ KCl RADIATION Int J Radiat Oncolo Biol Phys 29:17-23, 1994 ___________________________________________
Anal Cancer & HPV: HPV-16 Histologic Types: Squamous 47% Transitional (Cloacogenic) 27% Adenocarcinoma 15% Carcinoma NOS 3% Pappilary Villous adeno 3% Mucinous adeno 2% Melanoma 1% Other 2% Prognostic Factors: Tumor Size < 2Cm is associated with significantly better prognosis than > 2Cm ? Keratinizing tumors have better prognosis. However, in general histological subtype does not affect survival. TREATMENT: 1. SURGERY Surgical resection is used for treatment of lesions of the perianal area not involving the anal sphincter 2. PRIMARY RADIATION THERAPY 4500-7550 cGy with local control rates of 60-90% & 5-YR OS 32-90% 3. COMBINED-MODALITY TREATMENT The preferred treatment for most patients with anal cancer. Will obviate the need for an AP resection. 5FU+Mitomycin+XRT up to 5700 cGy have been used. 4-6 weeks after the completion of the therapy, a deep muscel biopsy of the anal scar is obtained. Those who still have positive biopsies will undergo AP resection. Link to NCI Web Site for Anal Cancer |