Epidermoid Cancers of the Anal Canal: Current Treatment

ABSTRACT

Epidermoid carcinoma of the anal canal is an uncommon disease, but has increased in incidence with the HIV epidemic. Prior to the 1970s, treatment consisted of radical surgery with abdominoperineal resection. With the pioneering work of Dr. Norman Nigro, this has shifted to a nonsurgical approach, with primary treatment consisting of multimodality therapy with radiation and chemotherapy. This review provides an overview of the historical, current, and future treatments of epidermoid anal canal malignancies.

KEYWORDS

Anal canal malignancy - epidermoid carcinoma - chemoradiation - Nigro protocol

REFERENCES

• 1 Mahmoud N N, Madoff R D. Investigation and management of malignant anal-canal tumours. In: Beynon J, Carr ND Progress in Colorectal Surgery. New York; Springer-Verlag 2005: 115-134
• 2 Klas J V, Rothenberger D A, Wong W D, Madoff R D. Malignant tumors of the anal canal: the spectrum of disease, treatment, and outcomes.  Cancer. 1999;  85(8) 1686-1693
• 3 Whiteford M H, Stevens Jr K R, Oh S, Deveney K E. The evolving treatment of anal cancer: how are we doing?.  Arch Surg. 2001;  136(8) 886-891
• 4 Wong S, Gibbs P, Chao M et al.. Carcinoma of the anal canal: a local experience and review of the literature.  ANZ J Surg. 2004;  74(7) 541-546
• 5 Lopez M J, Myerson R J, Shapiro S J et al.. Squamous cell carcinoma of the anal canal.  Am J Surg. 1991;  162(6) 580-584
• 6 Skibber J M, Eng C. Colon, rectal and anal cancer management. In: Chang AS, Ganz PA, Hayes DF, et al Oncology, An Evidence Based Approach. New York; Springer-Verlag 2006: 704-732
• 7 Salmon R J, Fenton J, Asselain B et al.. Treatment of epidermoid anal canal cancer.  Am J Surg. 1984;  147(1) 43-48
• 8 Mendenhall W M, Sombeck M D, Speer T W, Marsh R D, Carroll R R, Copeland III E M. Current management of squamous cell carcinoma of the anal canal.  Surg Oncol. 1994;  3(3) 135-146
• 9 Oehler-Jänne C, Huguet F, Provencher S et al.. HIV-specific differences in outcome of squamous cell carcinoma of the anal canal: a multicentric cohort study of HIV-positive patients receiving highly active antiretroviral therapy.  J Clin Oncol. 2008;  26(15) 2550-2557
• 10 Welton M L, Varma M G. Anal cancer. In: Wolff BG, Fleshman JW, Beck DE, et al The ASCRS Textbook of Colon and Rectal Surgery. New York; Springer-Verlag 2007: 482-500
• 11 Golden G T, Horsley III J S. Surgical management of epidermoid carcinoma of the anus.  Am J Surg. 1976;  131(3) 275-280
• 12 Nigro N D, Vaitkevicius V K, Considine Jr B. Combined therapy for cancer of the anal canal: a preliminary report 1974.  Dis Colon Rectum. 1993;  36 709-711
• 13 Nigro N D, Vaitkevicius V K, Buroker T, Bradley G T, Considine B. Combined therapy for cancer of the anal canal.  Dis Colon Rectum. 1981;  24(2) 73-75
• 14 Nigro N D, Seydel H G, Considine B, Vaitkevicius V K, Leichman L, Kinzie J J. Combined preoperative radiation and chemotherapy for squamous cell carcinoma of the anal canal.  Cancer. 1983;  51(10) 1826-1829
• 15 UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research . Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin.  Lancet. 1996;  348(9034) 1049-1054
• 16 Bartelink H, Roelofsen F, Eschwege F et al.. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups.  J Clin Oncol. 1997;  15(5) 2040-2049
• 17 Flam M, John M, Pajak T F et al.. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study.  J Clin Oncol. 1996;  14(9) 2527-2539
• 18 Grabenbauer G G, Kessler H, Matzel K E, Sauer R, Hohenberger W, Schneider I HF. Tumor site predicts outcome after radiochemotherapy in squamous-cell carcinoma of the anal region: long-term results of 101 patients.  Dis Colon Rectum. 2005;  48(9) 1742-1751
• 19 Gretschel S, Warnick P, Bembenek A et al.. Lymphatic mapping and sentinel lymph node biopsy in epidermoid carcinoma of the anal canal.  Eur J Surg Oncol. 2008;  34(8) 890-894
• 20 Salama J K, Mell L K, Schomas D A et al.. Concurrent chemotherapy and intensity-modulated radiation therapy for anal canal cancer patients: a multicenter experience.  J Clin Oncol. 2007;  25(29) 4581-4586
• 21 Ajani J A, Winter K A, Gunderson L L et al.. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial.  JAMA. 2008;  299(16) 1914-1921
• 22 Glynne-Jones R, Meadows H, Wan S National Cancer Research Institute Anal Sub Group and Colorectal Clinical Oncology Group et al. EXTRA—a multicenter phase II study of chemoradiation using a 5 day per week oral regimen of capecitabine and intravenous mitomycin C in anal cancer.  Int J Radiat Oncol Biol Phys. 2008;  72(1) 119-126
• 23 James R, Meadows H, Wan S. ACT II: the second UK phase III anal cancer trial.  Clin Oncol (Royal College of Radiologists). , Editorial 2005;  17 364-366
• 24 Glynne-Jones R, Mawdsley S. Anal cancer: the end of the road for neoadjuvant chemoradiotherapy?.  J Clin Oncol. 2008;  26(22) 3669-3671
• 25 Fleshner P R, Chalasani S, Chang G J, Levien D H, Hyman N H, Buie W D. Standards Practice Task Force, American Society of Colon and Rectal Surgeons . Practice parameters for anal squamous neoplasms.  Dis Colon Rectum. 2008;  51(1) 2-9
• 26 Deniaud-Alexandre E, Touboul E, Tiret E et al.. Results of definitive irradiation in a series of 305 epidermoid carcinomas of the anal canal.  Int J Radiat Oncol Biol Phys. 2003;  56(5) 1259-1273
• 27 Mullen J T, Rodriguez-Bigas M A, Chang G J et al.. Results of surgical salvage after failed chemoradiation therapy for epidermoid carcinoma of the anal canal.  Ann Surg Oncol. 2007;  14(2) 478-483
• 28 Roohipour R, Patil S, Goodman K A et al.. Squamous-cell carcinoma of the anal canal: predictors of treatment outcome.  Dis Colon Rectum. 2008;  51(2) 147-153
• 29 Renehan A G, Saunders M P, Schofield P F, O'Dwyer S T. Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer.  Br J Surg. 2005;  92(5) 605-614
• 30 Akbari R P, Paty P B, Guillem J G et al.. Oncologic outcomes of salvage surgery for epidermoid carcinoma of the anus initially managed with combined modality therapy.  Dis Colon Rectum. 2004;  47(7) 1136-1144
• 31 Papaconstantinou H T, Bullard K M, Rothenberger D A, Madoff R D. Salvage abdominoperineal resection after failed Nigro protocol: modest success, major morbidity.  Colorectal Dis. 2006;  8(2) 124-129
• 32 Nilsson P J, Svensson C, Goldman S, Ljungqvist O, Glimelius B. Epidermoid anal cancer: a review of a population-based series of 308 consecutive patients treated according to prospective protocols.  Int J Radiat Oncol Biol Phys. 2005;  61(1) 92-102
• 33 Gerard J P, Chapet O, Samiei F et al.. Management of inguinal lymph node metastases in patients with carcinoma of the anal canal: experience in a series of 270 patients treated in Lyon and review of the literature.  Cancer. 2001;  92(1) 77-84
• 34 Swan M C, Furniss D, Cassell O CS. Surgical management of metastatic inguinal lymphadenopathy.  BMJ. 2004;  329(7477) 1272-1276
• 35 Wexler A, Berson A M, Goldstone S E et al.. Invasive anal squamous-cell carcinoma in the HIV-positive patient: outcome in the era of highly active antiretroviral therapy.  Dis Colon Rectum. 2008;  51(1) 73-81
• 36 Blazy A, Hennequin C, Gornet J M et al.. Anal carcinomas in HIV-positive patients: high-dose chemoradiotherapy is feasible in the era of highly active antiretroviral therapy.  Dis Colon Rectum. 2005;  48(6) 1176-1181
• 37 Place R J, Gregorcyk S G, Huber P J, Simmang C L. Outcome analysis of HIV-positive patients with anal squamous cell carcinoma.  Dis Colon Rectum. 2001;  44(4) 506-512
• 38 Stadler R F, Gregorcyk S G, Euhus D M, Place R J, Huber P J, Simmang C L. Outcome of HIV-infected patients with invasive squamous-cell carcinoma of the anal canal in the era of highly active antiretroviral therapy.  Dis Colon Rectum. 2004;  47(8) 1305-1309