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Anal Cancer

---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
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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
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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