title: Anal carcinoma: surgery does not influence prognosis when performed prior to concurrent radiochemotherapy.
abstract: BACKGROUND
  Concurrent radiochemotherapy (cRCT) is the standard-of-care for patients with locally advanced anal cancer. There is a subgroup of patients however, vastly with small tumors, which undergo local excision before combined modality treatment. It was suggested that local excision prior to cRCT might improve the local control in comparison with cRCT. We evaluated local excision in comparison to incisional biopsy in this setting.
  
  
  METHODS
  Between 2000 and 2005, 84 patients were included in the study. In the majority of patients, only incisional biopsy (INC) was performed for the histopathological verification. Other patients underwent surgery prior to the RCT course as excisional biopsy (EXC). The chemotherapy consisted of 5-fluorouracil (800/1000 mg/m(2)/d, 4 consecutive days, w 1, five) and mitomycin C (2 times 10 mg/m(2)). Radiotherapy was prescribed 45 at Gy.
  
  
  RESULTS
  All patients (T1-2) were available for analysis. 14% of patients had node-positive disease. For the entire series, at five years and eight years, the actuarial OAS rates were 71% and 54%, respectively; the DSS rates were 74% and 68%, respectively; and the DFS rates were 54% and 54%, respectively. The actuarial control rate achieved by the EXC group was 80% after five years, better than the one for the INC group at 64%. Univariate analysis showed that tumor stage T3-T4 (p=0.04), tumor size ≥6 cm (p<0.001), nodal stage N1-3 (p<0.00) and OTT >40 days (p=0.05) are significantly correlated with poorer local disease control. Local excision in comparison with INC did not prove to be significant for local disease control (p=0.45). No significance was found for pre-therapeutic prognostic factors age, gender, histological type and grading. Multivariate analysis showed that tumor size as continuous variable (p=0.02) and OTT (p=0.04) remained significant when adjusted for T-stage and nodal stage.
  
  
  CONCLUSIONS
  According to this highly qualitative trial, surgical excision prior to cRCT, did not improve results. cRCT was confirmed as the standard-of-care.
authors.affiliation: Department for Radiation Oncology, Charité School of Medicine and University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, Harun.Badakhshi@charite.de.
authors.forename: Harun
authors.initials: H
authors.lastname: Badakhshi
authors.forename: Volker
authors.initials: V
authors.lastname: Budach
authors.forename: Peter
authors.initials: P
authors.lastname: Wust
authors.forename: Reinhold
authors.initials: R
authors.lastname: Graf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001005:Anus Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D016685:Mitomycin; D005472:Fluorouracil
keywords: Anal carcinoma; local control; prognosis; radiochemotherapy