Abstract
Anal canal carcinoma is a rare gastro-intestinal cancer. Radiochemotherapy is the recommended primary treatment for patients with non-metastatic carcinoma; surgery is generally reserved for persistent or recurrent disease. Follow-up and surveillance after primary treatment is paramount to classify patients in those with complete remission, persistent or progressive disease. Locally persistent disease represents a clinically significant problem and its management remains subject of some controversy.The aim of this systematic review is to summarise recommendations for the primary treatment of anal canal carcinoma, to focus on the optimal time to consider residual disease as genuine persistence to proceed with salvage treatment, and to discern how this analysis might inform future clinical trials in management in this class of patients.
Highlights
Carcinoma of the anal canal is a human papilloma virus associated cancer affecting both men and women
Due to superior local control and survival, and due to a better quality of life, prospective randomized trials have established that the submission of a combination of radiotherapy (RT) and chemotherapy is the international standard of care for patients with anal canal cancer [2,3,4]
Two randomized trials tested whether cisplatin (CDDP) could be used instead of mitomycin C (MMC), but results failed in their objective [5,10]
Summary
Carcinoma of the anal canal is a human papilloma virus associated cancer affecting both men and women. Results from the UKCCCR randomised trial showed that 77% of patients, who had not complete tumour regression at the 6-week assessment, achieved a complete response of primary tumour to CRT treatment with longer follow-up [18]. Persistent disease may continue to regress even at 26 weeks after the end of CRT In these cases, it is possible that patients are submitted to abdominal-perineal resection but no cancer is found on histopathological examination. Randomised data reported the presence of residual tumour evaluated within 6 weeks following the end of treatment It was considered as initial local failure and a salvage surgery was proposed, but specific histological data are not available and it is difficult to argue if an early intervention was performed. The optimal time for surgical intervention remains uncertain; avoidance of unnecessary overtreatment and excessive delay in treatment are both important, and an
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