Multidisciplinary management of cancer of the anus

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Abstract
Anal margin cancers are treated by local excision, with radical surgery reserved only for invasive cancers or those associated with fistula or condylomata. Squamous cell cancers of the anal canal have been treated by abdominoperineal resection regardless of cell type. Radiation therapy alone has been advocated by some, and we initiated a study using a combination of radiation, chemotherapy, and surgery. This study includes 104 patients treated from December, 1971, to July, 1983. Routine abdominoperineal resection was discontinued by us in 1975 because chemoradiation therapy eliminated the primary lesion in 5 of the first 6 patients. In the series, gross tumor disappeared in 97 patients after chemoradiation therapy. Radical operation was done routinely in 24 patients, for residual disease in 7, and for recurrent disease in 7 others. There were 21 deaths of which 13 were due to cancer of the anal canal. Large primary lesions and recurrent local disease account for the majority of deaths due to cancer. The 5‐year survival rate is projected to be 83%, with 65 patients followed for at least 5 years. Under our current regimen only 16 of the 38 patients would have had radical surgery. Chemoradiation therapy is advocated for all patients with squamous cell cancer of the anal canal and for invasive cancers of the anal margin. Patients with large (6–8 cm) primary cancers and those with recurrent disease should have additional chemoradiation therapy and/or abdominoperineal resection of the rectum.