title: Effectiveness of surgical salvage therapy for patients with locally uncontrolled anal carcinoma after sphincter-conserving treatment.
abstract: BACKGROUND
  Locally persistent or recurrent anal carcinoma represents a clinically significant problem, the management of which remains the subject of some controversy. Although the few current data suggest that radical surgery remains the sole salvage treatment able to provide some chance of cure, some authors have reported disappointingly low success rates. The current study presents the outcome of patients who failed locally after receiving radiotherapy or chemoradiotherapy for anal carcinoma.
  
  
  METHODS
  Of 185 consecutive patients treated between January 1976 and December 1996 with sphincter conservation, 42 subsequently presented with local failure, either alone (27 patients) or with regional or distant metastases (15 patients). Nine patients (21%) received supportive care only, 7 patients (17%) received palliative therapy, and 26 patients (62%) underwent potentially curative surgical salvage treatment, including 23 abdominoperineal resections (APR) and 3 local excisions. The median follow-up after local failure for all patients was 21.5 months (range, 1-231 months).
  
  
  RESULTS
  With the exception of 2 patients who committed suicide, all patients who did not undergo surgical salvage therapy died of progressive disease. Among 26 patients who received curative treatment, 11 ultimately achieved disease control. The 5-year overall survival rate after the diagnosis of local failure was 28% for all patients and 44.5% for those receiving curative salvage treatment. For the latter group the 5-year actuarial secondary local and locoregional control rates were 53% and 43%, respectively.
  
  
  CONCLUSIONS
  Although APR no longer is the first-line treatment of patients with anal carcinoma, it continues to play an essential role in salvage therapy, resulting in ultimate disease control in approximately 50% of patients with isolated local failure. The curative potential of secondary surgical treatment suggests the possible importance of early detection of persistent or recurrent local disease after nonsurgical, sphincter-conserving therapy.
authors.affiliation: Division of Radiation Oncology, Geneva University Hospital, Switzerland.
authors.forename: A S
authors.initials: AS
authors.lastname: Allal
authors.forename: F M
authors.initials: FM
authors.lastname: Laurencet
authors.forename: M A
authors.initials: MA
authors.lastname: Reymond
authors.forename: J M
authors.initials: JM
authors.lastname: Kurtz
authors.forename: M C
authors.initials: MC
authors.lastname: Marti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D017211:Treatment Failure