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Combined Modality Treatment of Anal Carcinoma

^a Bethesda Krankenhaus, Essen, Germany; ^b The Netherlands Cancer Institute/Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, The Netherlands

Correspondence: F. Roelofsen, M.D., Department of Surgery, Bethesda Krankenhaus, Bocholderstrasse 11-13, 45355 Essen, Germany. Telephone: +49-201-8650; Fax: +49-201-865-1409.

Within the framework of two phase III clinical trials, the superior results of concomitant chemotherapy and radiotherapy in the treatment of patients with locally advanced anal carcinoma were demonstrated. A further phase III clinical trial showed that the role of mitomycin C as part of the concomitant chemotherapy in combination with 5-fluorouracil appeared to be essential in obtaining a higher local control rate.

All three of these randomized trials have shown that this improved local control rate results in a reduction of the colostomy rate. The standard treatment for locally advanced anal carcinoma is therefore the concomitant use of chemotherapy and radiotherapy.

Future issues to be clarified include a search for the optimal radiation dose and the use of less toxic agents. For smaller tumors, the addition of chemotherapy still has to be assessed.

Key Words. Combined modality treatment • Radiochemotherapy • Anal carcinoma