title: Multimodal therapy of anal cancer added by new endosonographic-guided brachytherapy.
abstract: BACKGROUND
  The most appropriate therapy for anal cancer is external beam radiotherapy (EBRT) combined with chemotherapy (CTX). The significance of additional brachytherapy is still under evaluation. We report on our experience of combined modality therapy of anal cancer and transrectal ultrasound (TRUS)-guided high-dose rate (HDR) afterloading therapy, referring to results of a study published in 1998 by the coauthors.
  
  
  METHODS
  From 1993 to 2001, 50 patients with anal cancer were treated. After combined RCTX, HDR 2 x 4 Gy brachytherapy was administered based on TRUS imaging as a target.
  
  
  RESULTS
  In five patients (10%), tumor recurrence occurred or the tumor did not respond to therapy, and four (8%) developed distant lymph nodes or organ metastases. Five patients (10%) had to undergo salvage abdominoperineal resection because of suspected recurrence. Specific disease-related 5-year survival was 82%. Therapy-associated complications in terms of sphincter necrosis and incontinence were observed in three patients (6%).
  
  
  CONCLUSIONS
  TRUS-guided brachytherapy permits excellent local tumor control and results in minimal treatment-related morbidity. Consequently, TRUS-guided brachytherapy may be a useful addition to current combined modality treatment regimens for anal cancer.
authors.affiliation: Clinic for General and Thoracic Surgery, University Clinic of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 7, 24105 Kiel, Germany.
authors.forename: J M
authors.initials: JM
authors.lastname: Doniec
authors.forename: B
authors.initials: B
authors.lastname: Schniewind
authors.forename: G
authors.initials: G
authors.lastname: Kovács
authors.forename: V
authors.initials: V
authors.lastname: Kahlke
authors.forename: M
authors.initials: M
authors.lastname: Loehnert
authors.forename: B
authors.initials: B
authors.lastname: Kremer
mesh_terms: D000368:Aged; D001005:Anus Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000601:surgery; D001918:Brachytherapy / Q000009:adverse effects; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D019160:Endosonography; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D019233:Retreatment; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome