[Chemoradiotherapy and anal canal cancer].
Local control and sphincter preservation are the two challenges of anal canal cancer treatment. These tumors are radio- and chemo-sensitive and treatment moved from surgical approach, with abdominoperineal resection, to definitive radiation therapy with or without concurrent chemotherapy. Randomised trials proved the benefit of combined modality with chemoradiotherapy and of mitomycine C (MMC) compared with radiotherapy alone, with a toxic death rate of about 2%. Indications of chemoradiotherapy are locally advanced tumor T2 > or = 4 cm, T3-4 or N1-3 but the best modalities of combined treatment are still under debate. Standard chemotherapy is 5 flurouracile (5FU) + MMC, but cisplatinum (CDDP) is an effective and well tolerated substitute for MMC. Favourable results with CDDP-containing regimen in term of toxicity and carcinologic control have been reported in phase II and retrospective studies. Total radiation dose, overall duration of radiation therapy, duration of the gap and indications of additional boost are not clear, but it is demonstrated that overall duration of treatment should be as short as possible to improve the therapeutic radio. Phase II and III studies are ongoing, to evaluate the best chemotherapy regimen between 5FU+MMC and 5FU+CDDP, the benefit of neoadjuvant or maintenance chemotherapy and the interest of increased total dose. Next future could be the utilisation of oral 5FU. This article is a review of past randomised trials, phases II and retrospective study on radiochemotherapy of anal canal carcinoma.
Ortholan
Cécile
C
Centre Antoine-Lacassagne, 33, avenue Valombrose, Service de radiothérapie, 06189 Nice Cedex 2. cecile.ortholan@wanadoo.fr
François
Eric
E
Gérard
Jean-Pierre
JP
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy / Q000379:methods; D005472:Fluorouracil / Q000008:administration & dosage; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D016685:Mitomycin / Q000008:administration & dosage; D011743:Pyrimidines / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic
D011743:Pyrimidines; D016685:Mitomycin; D005472:Fluorouracil