National Cancer Institute®
Last Modified: June 1, 2002
UI - 11938066
AU - Vatra B; Sobhani I; Aparicio T; Girard PM; Puy Montbrun TD; Housset M;
TI - Baillet F; Hecht F; Chossidow D; Soule JC [Anal canal squamous-cell carcinomas in HIV positive patients: clinical features, treatments and prognosis]
SO - Gastroenterol Clin Biol 2002 Feb;26(2):150-6
AD - FAMA de Colo-Proctologie, Hopital Bichat-Claude Bernard, Paris, France.
The prevalence of squamous-cell carcinoma of the anus seems to be increasing in HIV positive patients. Clinical features and prognosis in this population have not been well evaluated.AIMS: To assess the prognosis of anal squamous-cell carcinoma in HIV positive patients as well as clinical features and treatment procedures.METHODS: A series of 20 HIV positive patients presenting with invasive anal squamous-cell carcinoma was retrospectively analyzed. Data have been compared to those obtained from 24 randomly selected HIV negative patients who were followed during the same periods in the same centers for anal carcinoma with similar histopathological features.RESULTS: The follow-up ranged from 10 to 172 months. No difference was observed between the two groups concerning the clinical features leading to anal cancer diagnosis, although HIV positive patients were younger. Anal cancer was more frequently associated with lymph node metastasis in HIV positive (60%) than in HIV negative (17%) patients, although its size was similar in both groups. Radiotherapy was similarly performed in both groups, while chemotherapy was administered less frequently in HIV positive than in HIV negative patients (54% vs 25%). Immediate side effects and mortality at 1 year follow-up were similar in both groups, whereas the objective initial response to therapy (50% versus 88%), the remission rate with anal conservation at 1 year follow-up (45% versus 88%), and the mortality at 3 years were better in HIV negative patients.CONCLUSION: The prognosis of anal squamous-cell carcinoma is poor in HIV positive patients. This correlates with a more advanced tumor stage and an alteration of systemic immunity status at the time of diagnosis and less response rate to treatment. Detection of precancerous lesions and treatment procedures should be evaluated in HIV infected patients.
UI - 11889676
AU - Viale PH
TI - Large hyperpigmented perianal tumor.
SO - Clin J Oncol Nurs 2002 Mar-Apr;6(2):116-7, 120
AD - Santa Clara Valley Medical Center, San Jose, CA, USA.
Anorectal melanomas are rare tumors that occur more frequently with advancing age and peak in the sixth and seventh decades (Felz et al., 2001). Surgery is considered to be optimal therapy; however, chemotherapy and immunotherapy have been shown to be effective in a small number of patients.
UI - 11985979
AU - van der Wal BC; Cleffken BI; Gulec B; Kaufman HS; Choti MA
TI - Results of salvage abdominoperineal resection for recurrent anal carcinoma following combined chemoradiation therapy.
SO - J Gastrointest Surg 2001 Jul-Aug;5(4):383-7
AD - Department of Surgery, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD 21287-5614, U.S.A.
Combined chemotherapy and radiation therapy is the standard treatment for epidermoid carcinoma of the anal canal. Failures are often not associated with distant recurrence and are therefore potentially amenable to salvage abdominoperineal resection. The aim of this study was to review our experience with abdominoperineal resection following failure of chemoradiation therapy for epidermoid carcinoma of the anus. Between 1980 and 1998, 17 patients underwent salvage abdominoperineal resection following failure of chemoradiation therapy. Four patients were excluded from survival analysis because resection was performed with palliative intent. Survival curves were based on the method of Kaplan and Meier, and univariate analysis of predictive variables was performed using the log-rank test. Twelve patients underwent abdominoperineal resection for persistent disease and five patients for recurrent disease. No operative deaths occurred, but local complications including perineal wound infection and wound breakdown was seen in 8 of 17 patients and 6 of 17 patients, respectively. Patients undergoing omental flap reconstruction (n = 3) or no pelvic reconstruction (n = 5) had a higher incidence of perineal breakdown compared to those undergoing muscle flap reconstruction (n = 9) (P <0.05). The median follow-up time for the patients operated on with curative intent was 53 months. The 5-year actuarial survival was 47%. Potential prognostic factors that were not found to have an impact on survival included margin status of resection, sphincter invasion, and degree of differentiation. Only pathologic tumor size greater than 5.0 cm (P <0.001) and age over 55 years (P <0.05) adversely affected survival. Selected patients with recurrent or persistent anal carcinoma following chemoradiation therapy can be offered salvage abdominoperineal resection. This operation is associated with a high incidence of local wound complications, and muscle flap reconstruction should be considered when possible. Prolonged survival can be achieved in some patients following salvage resection for epidermoid carcinoma of the anal canal.
UI - 11240240
AU - Kapp KS; Geyer E; Gebhart FH; Oechs AC; Berger A; Hebenstreit J; Stoeger
TI - H Experience with split-course external beam irradiation +/- chemotherapy and integrated Ir-192 high-dose-rate brachytherapy in the treatment of primary carcinomas of the anal canal.
SO - Int J Radiat Oncol Biol Phys 2001 Mar 15;49(4):997-1005
AD - Division of Radiation Oncology, Department of Radiology, Karl-Franzens University Medical School, Graz, Austria. email@example.com
PURPOSE: The effect of the treatment of anal cancer by performing a high-dose-rate (HDR) brachytherapy boost during a short split between the external beam radiotherapy series (EBR) +/- chemotherapy was investigated. METHODS AND MATERIALS: Thirty-nine patients with anal canal cancers, stages T1-T4 N0-2 M0, were treated with split-course EBR (50-50.4 Gy) and a Iridium 192 ((192)Ir-) HDR boost (6 Gy) performed during the 1-2-week split. Patients who failed to achieve a complete tumor response received additional brachytherapy. Chemotherapy with 5-fluorouracil and mitomycin C was offered to patients with tumors > 3 cm and employed concomitantly on days 1-5 and day 1, respectively, of each EBR series. RESULTS: Follow-up ranged from 3 to 140 months (median 31). Median treatment duration was 56 days. The 3-year (5-year) actuarial rates of locoregional control (LRC) and disease-specific survival (DSS) were 81% (76%) and 80% (76%), respectively. The crude rate of anal preservation was 77% overall, and 97% in patients in whom LRC was achieved. Uncompromised anal function was recorded in 93% of these patients. The actuarial 3-year (5-year) rate of colostomy-free survival (CFS) was 78% (73%). There was a statistically significant difference in LRC and DSS according to stage, tumor size, and nodal status. Complications requiring surgical intervention occurred in 7.6% of patients. CONCLUSION: The integration of the HDR boost in a split-course EBR regimen +/- chemotherapy resulted in excellent sphincter function without an increase of severe complications and with rates of LRC, DSS, and CFS, which compare favorably with those reported in the literature.
UI - 11872307
AU - Vordermark D; Koelbl O
TI - In regard to Kapp et al.: experience with split-course external beam irradiation +/- chemotherapy and integrated (192)Ir high-dose-rate brachytherapy in the treatment of primary carcinomas of the anal canal. IJROBP 2001;49:997--1005.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):580-1
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