title: Epidermoid anal cancer: a review of a population-based series of 308 consecutive patients treated according to prospective protocols.
abstract: OBJECTIVE
  The primary therapy in epidermoid anal cancer is radiotherapy, generally with chemotherapy. The use of neoadjuvant chemotherapy has been infrequently reported in the literature. This study presents results from a large population-based series and provides comparisons between different treatments.
  
  
  METHODS
  Between 1985 and 2000, 308 patients with invasive epidermoid anal cancer were diagnosed in the Stockholm Health Care Region. Treatment was given according to defined protocols. External beam radiotherapy alone or with concomitant bleomycin and neoadjuvant chemotherapy followed by radiotherapy alone were the primary treatments. Radical surgery was reserved for poor responders or recurrences. Data were reviewed with regard to treatment, outcome, and prognostic factors.
  
  
  RESULTS
  Among the 276 patients (90%) treated with curative intent, 264 (96%) received treatment in accordance with the protocols. The overall 5-year survival rate was 68%. Among the 142 patients with locally advanced tumors (T > or =4 cm or N+), patients treated with neoadjuvant platinum-based chemotherapy (n = 91) had significantly better complete response rates compared with patients treated with radiotherapy with or without bleomycin (n = 51) (92% vs. 76%, p < 0.01). A significantly increased overall 5-year survival rate was also found among patients receiving neoadjuvant therapy (63% vs. 44%, p < 0.05).
  
  
  CONCLUSIONS
  Structured treatment protocols result in favorable outcome on a population level. The results further suggest a significant therapeutic gain from including neoadjuvant chemotherapy in the treatment of locally advanced anal cancer.
authors.affiliation: Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden. per.nilsson@ersta.se
authors.forename: Per J
authors.initials: PJ
authors.lastname: Nilsson
authors.forename: Christer
authors.initials: C
authors.lastname: Svensson
authors.forename: Sven
authors.initials: S
authors.lastname: Goldman
authors.forename: Olle
authors.initials: O
authors.lastname: Ljungqvist
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000401:mortality / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D013223:Statistics as Topic; D015996:Survival Rate; D016896:Treatment Outcome