title: Management of primary anal canal adenocarcinoma: a large retrospective study from the Rare Cancer Network.
abstract: OBJECTIVE
  Primary adenocarcinoma of the anus is a rare tumor. The current standard treatment consists of abdominoperineal resection (APR). The aim of this Rare Cancer Network study was to evaluate the prognostic factors and outcome after the three most commonly used treatment approaches.
  
  
  METHODS
  This multicenter study collected data from 82 patients: 15 with T1 (18%), 34 with T2 (42%), 22 with T3 (27%), and 11 with T4 (13%) tumors according to the TNM classification (International Union Against Cancer, 1997). Patients were separated into, and analyzed according to, three treatment categories: radiotherapy/surgery (RT/S group, n = 45), combined radiochemotherapy (RT/CHT group, n = 31), and APR alone (APR group, n = 6). The main patient characteristics were evenly distributed among the three groups.
  
  
  RESULTS
  The actuarial locoregional relapse rate at 5 years was 37%, 36%, and 20%, respectively, in the RT/S, RT/CHT, and APR groups (RT/S vs. RT/CHT, p = 0.93; RT/CH vs. APR, p = 0.78). The 3-, 5-, and 10-year overall survival rate was 47%, 29%, and 23% in the RT/S group, 75%, 58%, and 39% in the RT/CHT group, and 42%, 21%, and 21% in the APR group (RT/CHT vs. RT/S, p = 0.027), respectively. The 5- and 10-year disease-free survival rate was 25% and 18% in the RT/S group, 54% and 20% in the RT/CHT group, and 22% and 22% in the APR group (RT/CHT vs. RT/S, p = 0.038), respectively. Multivariate analysis revealed four independent prognostic factors for survival: T stage, N stage, histologic grade, and treatment modality.
  
  
  CONCLUSIONS
  Primary adenocarcinoma of the anal canal requires rigorous management. Multivariate analysis showed that T and N stage, histologic grade, and treatment modality are independent prognostic factors for survival. We observed better survival rates after combined RT/CHT. We also recommend using APR only for salvage treatment.
authors.affiliation: Radiation Therapy, Oscar Lambret Center, Lille, France
authors.forename: Yazid
authors.initials: Y
authors.lastname: Belkacémi
authors.forename: Christine
authors.initials: C
authors.lastname: Berger
authors.forename: Philip
authors.initials: P
authors.lastname: Poortmans
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Piel
authors.forename: Abderrahim
authors.initials: A
authors.lastname: Zouhair
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Méric
authors.forename: Tan-Dat
authors.initials: TD
authors.lastname: Nguyen
authors.forename: Marco
authors.initials: M
authors.lastname: Krengli
authors.forename: Franck
authors.initials: F
authors.lastname: Behrensmeier
authors.forename: Abdelkarim
authors.initials: A
authors.lastname: Allal
authors.forename: Dany
authors.initials: D
authors.lastname: De Looze
authors.forename: Jacques
authors.initials: J
authors.lastname: Bernier
authors.forename: Luciano
authors.initials: L
authors.lastname: Scandolaro
authors.forename: René-Olivier
authors.initials: RO
authors.lastname: Mirimanoff
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure