title: Organ-preserving multimodality management of squamous cell carcinoma of anal canal.
abstract: OBJECTIVE
  To study the efficacy of an organ-preserving, sequential chemoradiation therapy for squamous cell carcinoma of the anal canal, and of salvage surgery in those in whom this treatment fails.
  
  
  METHODS
  Forty biopsy-proven untreated patients (28 men) with squamous cell carcinoma of the anal canal received two cycles of chemotherapy using cisplatin and methotrexate, followed by 45 to 60 (median 50) Gy external beam radiotherapy. Salvage surgery was offered to those in whom this treatment failed. Overall survival, disease-free survival and colostomy-free survival were analyzed.
  
  
  RESULTS
  Most patients (n=35; 87%) had T3 or T4 lesions and 5 (12.5%) had involvement of inguinal nodes. Thirty-one patients (77.5%) had complete response after chemoradiation. Only three patients (7.5%) developed chemotherapy-related grade 3 mucositis and myelosuppression. Radiotherapy-related toxicity included grade III cystitis in one patient and grade III proctitis in three patients. Three patients had post-treatment anal stenosis requiring repeated dilatation and two had chronic non-healing ulcers at the anal verge. Nine patients had failure of chemoradiation or disease recurrence; of these, only 5 could undergo salvage surgery. After a median follow up of 60 months, overall survival, disease-free survival and colostomy-free survival were 80%, 77.5% and 72.5%, respectively.
  
  
  CONCLUSIONS
  Chemoradiation is effective in the treatment of squamous cell anal cancer and has acceptable toxicity. Surgical salvage may be useful in those with failure of this treatment.
authors.affiliation: Department of Surgical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi. svsdeo@yahoo.co.in
authors.forename: S V
authors.initials: SV
authors.lastname: Deo
authors.forename: N K
authors.initials: NK
authors.lastname: Shukla
authors.forename: V
authors.initials: V
authors.lastname: Raina
authors.forename: B K
authors.initials: BK
authors.lastname: Mohanti
authors.forename: Rajeev
authors.initials: R
authors.lastname: Sharan
authors.forename: Madhabananda
authors.initials: M
authors.lastname: Kar
authors.forename: G K
authors.initials: GK
authors.lastname: Rath
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000628:therapy*; D002945:Cisplatin / Q000627:therapeutic use; D003125:Colostomy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D016879:Salvage Therapy
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin; D008727:Methotrexate