title: Successful closure of anal cancer-related fistulas with upfront intra-arterial chemotherapy: a report of 8 cases.
abstract: BACKGROUND
  Fistulas arising from the perforation of anal cancer into adjacent organs are a debilitating complication in the course of the disease.
  
  
  OBJECTIVE
  We studied intra-arterial chemotherapy as a strategy to close such fistulas before the initiation of standard chemoradiation.
  
  
  METHODS
  This study was based on a retrospective chart review.
  
  
  METHODS
  The investigation was conducted at Geneva University Hospital.
  
  
  METHODS
  Eight patients with anal cancer-related fistulas were included in the study.
  
  
  METHODS
  Patients were treated at our institution from 2002 to 2009 with upfront chemotherapy consisting of 1 to 4 cycles of intra-arterial cisplatin, 5-fluorouracil, methotrexate, and mitomycin C, and intravenous bleomycin. Intra-arterial chemotherapy was followed by standard chemoradiation.
  
  
  METHODS
  Fistula closure was assessed by an expert proctologist.
  
  
  RESULTS
  Complete closure of fistulas was documented in 7 of 8 patients. Toxicity was manageable and consisted mainly of thrombocytopenia, neutropenia, and febrile neutropenia as well as fatigue.
  
  
  CONCLUSIONS
  This is a retrospective, uncontrolled review of only 8 patients and thus a meaningful comparison with standard chemoradiation is not feasible.
  
  
  CONCLUSIONS
  Upfront intra-arterial chemotherapy is a promising strategy to close anal cancer-related fistulas before initiating chemoradiation, potentially obviating the need for hazardous reconstructive surgery after radiotherapy.
authors.affiliation: Division of Oncology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Kridel
authors.forename: Stéphane
authors.initials: S
authors.lastname: Cochet
authors.forename: Bruno
authors.initials: B
authors.lastname: Roche
authors.forename: Albéric
authors.initials: A
authors.lastname: Bressoud
authors.forename: Pascal
authors.initials: P
authors.lastname: Gervaz
authors.forename: Michael
authors.initials: M
authors.lastname: Betz
authors.forename: Arnaud D
authors.initials: AD
authors.lastname: Roth
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D003113:Colonoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D012004:Rectal Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents