title: Persisting perianal ulcer after radiotherapy for anal cancer: recurrence of disease or late radiation-related complication?
abstract: We report the case of a 47-year-old HIV-negative male affected by a perianal ulcer which occurred after chemoradiation delivered for anal cancer. In spite of a negative biopsy the lesion was highly suspected to be a disease recurrence. Uncontrollable pain and anal stenosis were also present; abdominoperineal resection with a large excision of perianal tissues and reconstruction with bilateral musculocutaneous gracilis flaps was therefore performed. Histology did not confirm tumor recurrence. Thirteen months after surgery, the patient is still alive and free of disease. The introduction of radiotherapy and concomitant chemotherapy has revolutionized the treatment of anal cancer, avoiding demolitive surgery in a large subset of patients. Radionecrosis is an uncommon but potentially devastating event occurring in up to 10% of patients undergoing radiotherapy for anal cancer. It causes clinical (pain, anal stenosis, mucositis and diarrhea) and diagnostic problems (recurrence vs. benign post-attinic lesion). In the present article we review this uncommon complication, discuss the technical surgical aspects associated with a very large perianal tissue removal, and data of the most recent literature in this field.
authors.affiliation: Department of General Surgery, Campus Bio-Medico University, Catholic University, Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Borzomati
authors.forename: Sergio
authors.initials: S
authors.lastname: Valeri
authors.forename: Valter
authors.initials: V
authors.lastname: Ripetti
authors.forename: Bruno
authors.initials: B
authors.lastname: Vincenzi
authors.forename: Carla
authors.initials: C
authors.lastname: Rabitti
authors.forename: Paolo
authors.initials: P
authors.lastname: Persichetti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.forename: Lucio
authors.initials: L
authors.lastname: Trodella
authors.forename: Marco
authors.initials: M
authors.lastname: Caricato
authors.forename: Roberto
authors.initials: R
authors.lastname: Coppola
mesh_terms: D001003:Anal Canal / Q000473:pathology / Q000601:surgery; D001005:Anus Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology; D010502:Perineum / Q000473:pathology / Q000528:radiation effects* / Q000601:surgery; D011855:Radiodermatitis / Q000175:diagnosis* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D013524:Surgical Flaps; D014456:Ulcer / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery