title: Buschke-Löwenstein tumor with squamous cell carcinoma treated with chemo-radiation therapy and local surgical excision: report of three cases.
abstract: Treatment of anorectal Buschke-Löwenstein tumor (BLT) with squamous cell carcinoma (SCC) transformation is not univocal given the rarity of the disease. BLT is characterized by its large size and tendency to infiltrate into underlying tissues. Malignant transformation can occur and it is important to identify the presence of neoplastic foci to decide the proper treatment. Our aim was to assess the effectiveness of neo-adjuvant chemo-radiation therapy (CRT) and local excision in order to avoid abdomino-perineal resection (APR). Three cases of anorectal BLT with SCC transformation are presented. All patients were HIV positive and treated with antiretroviral drugs. They underwent preoperative endoanal ultrasound, biopsies, total body tomography and anal brushing. Treatment consisted of neo-adjuvant chemo-radiation therapy (45 Gy to the pelvis plus a boost with 14.40 Gy to the primary tumor for a total of 59.40 Gy, and mitomycin-C in bolus on the first day, plus 5-fluorouracil by continuous infusion in the first and in the sixth week) and subsequent local surgical excision. During the follow-up, patients were subjected to the same preoperative diagnostic investigations and high resolution anoscopy. All patients showed a complete regression of the lesion after CRT and were treated by local surgical excision, thus avoiding permanent colostomy. In conclusion neo-adjuvant chemo-radiation therapy with local surgical excision could be considered an effective therapy in the treatment of anorectal BLT with SCC transformation to avoid APR.
authors.affiliation: Department of Surgery Pietro Valdoni - UOD of Surgery and Rehabilitation of the Pelvic Floor, Umberto I Policlinic of Rome, Sapienza University of Rome, Via Giovanni Maria Lancisi, Roma 2 00161, Italy. marileda.indinnimeo@uniroma1.it.
authors.forename: Marileda
authors.initials: M
authors.lastname: Indinnimeo
authors.forename: Alessio
authors.initials: A
authors.lastname: Impagnatiello
authors.forename: Gabriella
authors.initials: G
authors.lastname: D'Ettorre
authors.forename: Gloria
authors.initials: G
authors.lastname: Bernardi
authors.forename: Cosima Maria
authors.initials: CM
authors.lastname: Moschella
authors.forename: Paolo
authors.initials: P
authors.lastname: Gozzo
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciardi
authors.forename: Caterina
authors.initials: C
authors.lastname: Bangrazi
authors.forename: Francesca
authors.initials: F
authors.lastname: De Felice
authors.forename: Daniela
authors.initials: D
authors.lastname: Musio
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tombolini
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D062688:Buschke-Lowenstein Tumor / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002471:Cell Transformation, Neoplastic; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013514:Surgical Procedures, Operative
references.citation: Am Surg. 1998 Nov;64(11):1082-7
references.pmid: 9798775
references.citation: Lancet. 1996 Oct 19;348(9034):1049-54
references.pmid: 8874455
references.citation: J Cutan Pathol. 1998 Mar;25(3):165-70
references.pmid: 9550316
references.citation: Dis Colon Rectum. 1974 May-Jun;17(3):354-6
references.pmid: 4830803
references.citation: Histopathology. 1988 Mar;12(3):319-23
references.pmid: 2835300
references.citation: J Natl Compr Canc Netw. 2012 Apr;10(4):449-54
references.pmid: 22491045
references.citation: Dis Colon Rectum. 2001 Dec;44(12):1878-86
references.pmid: 11742180
references.citation: Anticancer Res. 2002 Mar-Apr;22(2B):1201-4
references.pmid: 12168925
references.citation: Dis Colon Rectum. 1994 Sep;37(9):950-7
references.pmid: 8076499
references.citation: Arch Pathol. 1965 Mar;79:225-31
references.pmid: 14246201
references.citation: Dis Colon Rectum. 2009 Feb;52(2):239-47
references.pmid: 19279418
references.citation: Adv Anat Pathol. 2008 Sep;15(5):263-78
references.pmid: 18724100
references.citation: Histopathology. 1985 Nov;9(11):1155-69
references.pmid: 4085991
references.citation: Dis Colon Rectum. 1989 Jun;32(6):481-7
references.pmid: 2791784
references.citation: Dermatology. 2007;215(3):264-5
references.pmid: 17823529
references.citation: Dis Colon Rectum. 1987 Apr;30(4):293-5
references.pmid: 3829876