Anal Canal Carcinoma Research Articles

Treatment of carcinoma of the anal canal at Groote Schuur Hospital

Chemoradiation is the treatment of choice for squamous carcinoma of the anal canal, resulting in the same local control rates as surgery but with the advantage of organ function preservation. We aimed to review all cases of anal canal carcinoma treated at Groote Schuur Hospital between 2000 and 2004 and to assess treatement outcome. The records for 31 patients presenting during this period were reviewed. Patient and tumour characteristics were recorded. Twenty-six patients were treated with chemoradiation. Local failure-free, colostomy-free and overall survival were calculated using the Kaplan-Meier method. Compared with the literature, the median patient age was younger and the stage was more advanced in this study. The complete response rate for all stages with chemoradiation was 80%. The local failure-free survival at 5 years was 60.7%. Colostomy-free and overall survival at 5 years were 59.2% and 65.6%, respectively. The patients presented with locally advanced disease. Chemoradiation is effective treatment for this group of patients and the majority avoid a permanent colostomy as they preserve anal sphincter function.

Induction Chemotherapy and Dose Intensification of the Radiation Boost in Locally Advanced Anal Canal Carcinoma: Final Analysis of the Randomized UNICANCER ACCORD 03 Trial

Concomitant radiochemotherapy (RCT) is the standard for locally advanced anal canal carcinoma (LAACC). Questions regarding the role of induction chemotherapy (ICT) and a higher radiation dose in LAACC are pending. Our trial was designed to determine whether dose escalation of the radiation boost or two cycles of ICT before concomitant RCT lead to an improvement in colostomy-free survival (CFS). Patients with tumors ≥ 40 mm, or < 40 mm and N1-3M0 were randomly assigned to one of four treatment arms: (A) two ICT cycles (fluorouracil 800 mg/m(2)/d intravenous [IV] infusion, days 1 through 4 and 29 to 32; and cisplatin 80 mg/m(2) IV, on days 1 and 29), RCT (45 Gy in 25 fractions over 5 weeks, fluorouracil and cisplatin during weeks 1 and 5), and standard-dose boost (SD; 15 Gy); (B) two ICT cycles, RCT, and high-dose boost (HD; 20-25 Gy); (C): RCT and SD boost (reference arm); and (D) RCT and HD boost. Two hundred eighty-three of 307 patients achieved full treatment. With a median follow-up period of 50 months, the 5-year CFS rates were 69.6%, 82.4%, 77.1%, and 72.7% in arms A, B, C, and D, respectively. Considering the 2 × 2 factorial analysis, the 5-year CFS was 76.5% versus 75.0% (P = .37) in groups A and B versus C and D, respectively (ICT effect), and 73.7% versus 77.8% in groups A and C versus B and D, respectively (RT-dose effect; P = .067). Using CFS as our main end point, we did not find an advantage for either ICT or HD radiation boost in LAACC. Nevertheless, the results of the most treatment-intense arm B should prompt the design of further intensification studies.

肛門ポリープ様病変で発見された肛門管粘液癌の1例

肛門ポリープ様病変で発見された肛門管粘液癌の1例

切除範囲の決定に術前mapping biopsyが有用であったpagetoid spreadを伴う肛門管癌の１例

切除範囲の決定に術前mapping biopsyが有用であったpagetoid spreadを伴う肛門管癌の１例

Metástasis endobronquiales de carcinoma del canal anal

Endobronchial metastases (EBM) secondary to extrapulmonary primary tumours are rare. The most common solid malignant tumours associated with EBM are breast, renal and colorectal carcinomas.This case report describes the first documented case of EBM from anal canal carcinoma. This neoplasm constitutes less than 1% of colorectal tumours.The clinical presentation of this entity is variable, being asymptomatic in more than 50% of cases. Generally, EBM are diagnosed in advanced stages and the survival after the diagnosis is poor.It is therefore an exceptional clinical manifestation in which bronchoscopy has an important role in the diagnosis and the treatment.

6051 POSTER Combined Modality Treatment in Anal Canal Carcinoma – Impact of Full Dose Treatment and Clinical Stage Category on Outcomes

6051 POSTER Combined Modality Treatment in Anal Canal Carcinoma – Impact of Full Dose Treatment and Clinical Stage Category on Outcomes

Epidermoid Cancer of the Anal Canal

Anal canal cancer is a rare cancer with incidence that continues to rise. This has been in large part due to increased prevalence of immunosuppressed conditions such as organ transplantation and human immunodeficiency virus along with transmission of the human papillomavirus. Identification of high-risk groups and close monitoring of these groups can help to detect earlier stages of cancer. Chemoradiation therapy remains the mainstay of treatment with excellent outcomes. Surgery for anal canal carcinoma remains as a salvage technique for failed chemoradiation or recurrent disease.

Radiothérapie conformationnelle avec modulation d’intensité des cancers de l’anus

Anal canal carcinoma are highly curable by irradiation, combined with chemotherapy in locally advanced disease, with preservation of sphincter function. The clinical target volume for the nodes is extended, often including the inguinal nodes, which is not usual for other pelvic tumours. Acute and late effects are correlated with the volume and dose delivered to organs at risk, i. e. small bowel, bladder and increased by concomitant chemotherapy. Intensity modulated irradiation (IMRT) makes it possible to optimize the dose distribution in this “complex U shaped” volume, while maintaining the dose distribution for the target volumes. The conversion from conformal irradiation to IMRT necessitates good knowledge of the definition and skills to delineate target volumes and organs at risk, including new volumes needed to optimize the dose distribution. Dosimetric and clinical benefits of IMRT are described, based on early descriptions and evidence-based publication. The growing development of IMRT in anal canal radiotherapy must be encouraged, and long-term benefits should be soon published. Radiation oncologists should precisely learn IMRT recommendations before starting the technique, and evaluate its early and late results for adverse effects, but also for long-term tumour control.

Twenty-year experience in the management of squamous cell anal canal carcinoma with interstitial brachytherapy

The aim of this study was to retrospectively evaluate clinical characteristics, local control, acute and late toxicity, and prognostic factors of patients with anal canal carcinoma treated with brachytherapy. From 1989 to 2009, 38 patients were treated with iridium 192 low-dose-rate (N = 26) or pulsed-dose-rate (N = 12) interstitial brachytherapy at a single institution. The median age was 62 years (range, 38-86 years). The TNM classification was as follows: 10 T1, 22 T2, 5 T3 and 1 T4; 32 N0, 3 N1 and 3 N2. Most patients (32/38) received either a first course of radiochemotherapy (N = 22) or radiotherapy alone (N=10) consisting of a total delivered dose of 45 Gy to the pelvis (range, 32-50) followed by a boost a median of 18 days later of 15-35 Gy (median 20 Gy) to the anal canal. The remaining 6 cases were treated with brachytherapy alone (dose range, 60-65 Gy). With a median follow-up of 30 months (range, 4-200), 2- and 5-year local control rates were 91% and 87%, respectively. Preservation of the anal sphincter was achieved in 32 patients (84%). Three patients experienced incontinence after brachytherapy. Only 2 patients showed chronic mucositis grade 3/4. Age proved to be a statistically significant prognostic factor for overall survival in the univariate (p = 0.033) and multivariate analyses (p = 0.018). Concurrent chemotherapy with external beam radiotherapy was a statistically significant prognostic factor for disease-free survival in the univariate and multivariate analyses (p = 0.007 and p = 0.044, respectively). Interstitial brachytherapy appears to be an effective and well tolerated treatment for anal carcinoma offering both high local tumour control and anal sphincter preservation.

Survival Rates Following Radical Resection for Persistent and Recurrent Anal Cancer Are Poor

PURPOSE: Sphincter-sparing chemoradiotherapy (CRT) is the standard of care for patients with anal canal cancer. Despite good response rates, some patients require radical surgery (abdominoperineal resection or exenteration)for persistent or recurrent disease. The purpose of this study was to evaluate the outcomes of patients following radical resection for persistent or recurrent disease. METHODS: All patients treated with CRT or RT for anal cancer between 1990 and 2008 were identified using the regional cancer registry. Inclusion criteria: pathologically confirmed squamous cell carcinoma of the anal canal, localized disease, receiving ≥ 45Gy of RT. Statistical analysis was conducted to calculate survival rates and identify risk factors for poor outcomes. RESULTS: 105 patients (25 male) were identified. Median age was 57 years (range 33-87 yr). Median follow up was 40 months (range 3185). Median T stage and size at presentation were 2 and 35 mm (range 6-260mm) respectively. Median dose to the primary tumor was 54 Gy (45-76 Gy) at a median 28 fractions (range 20-37). 92 patients(88.5%) received concurrent chemotherapy. At 3 month followup 85 (83.3%) patients had complete clinical response, one patient had insufficient followup. 19 (18.1%) patients had persistent disease, of whom 12 underwent radical resection for cure; 5 (41.7%) are alive at a median of 106 months from diagnosis, while the remaining 7 died at a median 15 months from diagnosis. Recurrence occurred in 17 (20.0 %) patients at a median time of 9 months (4-53m). 8 patients underwent radical resection for recurrence; 2 (25.0%) patients are alive at 127 and 21 months, the remaining 6 died at a median time from recurrence of 24.5 months. Overall, disease specific and disease free survival, were 66%, 71% and 67% respectively for all anal canal carcinoma patients at 5 years. Multivariate analysis showed tumor size to be a significant risk factor for disease free (aOR 1.02, 95% CI: 1.01-1.04) and overall survival (aOR 1.03, 95% CI: 1.01-1.04) for all patients. CONCLUSION: Despite good response rates to sphincter-sparing therapy, 20% still required radical resection for persistent or recurrent disease. Survival rates following radical resection are poor.

Short Term Outcomes After Colorectal Surgery in Octogenarians

PURPOSE: Sphincter-sparing chemoradiotherapy (CRT) is the standard of care for patients with anal canal cancer. Despite good response rates, some patients require radical surgery (abdominoperineal resection or exenteration)for persistent or recurrent disease. The purpose of this study was to evaluate the outcomes of patients following radical resection for persistent or recurrent disease. METHODS: All patients treated with CRT or RT for anal cancer between 1990 and 2008 were identified using the regional cancer registry. Inclusion criteria: pathologically confirmed squamous cell carcinoma of the anal canal, localized disease, receiving ≥ 45Gy of RT. Statistical analysis was conducted to calculate survival rates and identify risk factors for poor outcomes. RESULTS: 105 patients (25 male) were identified. Median age was 57 years (range 33-87 yr). Median follow up was 40 months (range 3185). Median T stage and size at presentation were 2 and 35 mm (range 6-260mm) respectively. Median dose to the primary tumor was 54 Gy (45-76 Gy) at a median 28 fractions (range 20-37). 92 patients(88.5%) received concurrent chemotherapy. At 3 month followup 85 (83.3%) patients had complete clinical response, one patient had insufficient followup. 19 (18.1%) patients had persistent disease, of whom 12 underwent radical resection for cure; 5 (41.7%) are alive at a median of 106 months from diagnosis, while the remaining 7 died at a median 15 months from diagnosis. Recurrence occurred in 17 (20.0 %) patients at a median time of 9 months (4-53m). 8 patients underwent radical resection for recurrence; 2 (25.0%) patients are alive at 127 and 21 months, the remaining 6 died at a median time from recurrence of 24.5 months. Overall, disease specific and disease free survival, were 66%, 71% and 67% respectively for all anal canal carcinoma patients at 5 years. Multivariate analysis showed tumor size to be a significant risk factor for disease free (aOR 1.02, 95% CI: 1.01-1.04) and overall survival (aOR 1.03, 95% CI: 1.01-1.04) for all patients. CONCLUSION: Despite good response rates to sphincter-sparing therapy, 20% still required radical resection for persistent or recurrent disease. Survival rates following radical resection are poor.

Light microscopic observation on phagocytosis of Candida spp. blastospores by Trichomonas vaginalis in a patient with anal canal carcinoma

Light microscopic observation on phagocytosis of Candida spp. blastospores by Trichomonas vaginalis in a patient with anal canal carcinoma

Identificação do papilomavírus humano em doentes com carcinoma de células escamosas do canal anal e sua relação com o grau de diferenciação celular e estadiamento

OBJETIVO: Identificar os tipos de papilomavírus humano (HPV) nos portadores de carcinoma do canal anal (CCA), relacionando-os ao grau de diferenciação celular e estadiamento da lesão, em pacientes do Belém, Pará, entre 1998 e 2000. MÉTODOS: Foi realizado um estudo de caso-controle com 75 pacientes, divididos em: Grupo Teste, com 33 portadores de carcinoma do canal anal, e o Grupo Controle, com 42 portadores de doenças não-neoplásicas do canal anal. Os tipos virais foram identificados por PCR e dot blot. O teste exato de Fischer foi utilizado para avaliar a ocorrência de HPV. Adotou-se a tabela de contingência 3x2 para representar a distribuição dos tipos de HPV. Nos testes de hipóteses, foi prefixado o nível de significância α=0,05 para a rejeição da hipótese de nulidade. RESULTADOS: A prevalência do HPV foi significante entre os Grupos Teste (60,6%) e Controle (26,2%) (p=0,0027). Os tipos virais mais comuns foram 16 (42,4%) e 18 (15,2%). Observaram-se diferenças entre grupos na prevalência do HPV 16 (p=0,027) e 18 (p=0,043) no Grupo Teste, e o tipos 16 (19,0%,) e 18 em (2,4%) no Grupo Controle. No Grupo Teste, avaliou-se a distribuição dos tipos de HPV em relação ao estadiamento e ao grau de diferenciação celular, não apresentando diferenças estatisticamente significativas. CONCLUSÃO: O carcinoma de células escamosas do canal anal está associado à presença de HPV, e os tipos 16 e 18 são os mais frequentes

Anal canal carcinoma treatment results: the experience of a single institution

BACKGROUND AND OBJECTIVES:Prior to the mid-1980s, the treatment of choice for anal cancer was abdominoperineal resection. Currently, combined chemoradiation is the standard of care. Or objective was to analyze results of treatment for anal canal carcinoma treated with combined chemoradiation.DESIGN AND SETTING:0Retrospective review of data in local cancer registry at King Faisal Specialist Hospital and Research Centre (KFSHRC) from a 12-year period (1993 to 2005).METHODS:We identified patients with confirmed diagnosis of anal canal squamous cell carcinoma.RESULTS:Of 40 patients identified, 33 were considered eligible for our analysis. All patients were treated by concurrent chemoradiation with mandatory treatment break (MTB) There were 10 (30%) local recurrences. Five-year progression-free survival (PFS) was 50.9%; overall survival (OS) at 5 years was 73.4%. Patients with stage II disease had a median PFS period of 10 years, with no relapses until their last follow-up. There was no statistically significant difference in PFS between patients with stage IIIA disease and those with stage IIIB disease—44.7% and 45%, respectively (P=.8). Five-year PFS according to ‘T’ stages was as follows: T1, 66%; T2, 71%; T3, 59%; T4, 30% (P>.05). The 5-year colostomy-free survival (CFS) for all patients was 74%. Distant metastases were observed in 4 patients.CONCLUSION:Combined chemoradiation in treatment of anal cancer is effective in terms of local control and sphincter preservation. Five-year estimates of PFS, OS, as well as CFS, in patients treated with a MTB were surprisingly comparable to those determined in most non-MTB series. However, we reported a higher local failure rate, for which we are reevaluating our treatment protocol.

Anal Canal Carcinoma Treatment Results: The Experience of a Single Institution

Anal Canal Carcinoma Treatment Results: The Experience of a Single Institution

The Role of EGFR Inhibitors in the Treatment of Metastatic Anal Canal Carcinoma: A Case Series

Anal cancer patients who have exhibited disease progression after having received all approved drugs pose a major therapeutic challenge. In addition to cytotoxic agents, novel targeted agents are being developed and have an established role in the treatment of many solid tumors, including colon cancer. However, their role in anal cancer is yet to be determined. Most anal malignancies are squamous cell carcinomas often strongly expressing epidermal growth factor receptors (EGFRs). Targeting the latter seems to result in favorable changes in tumor growth. We present three cases of refractory anal cancers, treated with EGFR inhibitors, after having received the recommended chemotherapy regimens. We conclude that EGFR inhibitors may play a vital role in the treatment of anal cancer and we suggest that large trials are be conducted in order to clarify their efficacy and to improve therapeutic management.

Post burn Marjolin's ulcer in the natal cleft mimicking anal canal carcinoma: a rare site

Marjolin's ulcer is a recognised complication of burn scars, chronic sinuses, and at sites of chronic irritation. The majority of these wounds occur at either venous ulcer or burn sites, usually in the extremities or the trunk. The only current method for confirming diagnosis is biopsy, which if positive will be followed by wide local excision and skin coverage. This paper reports an unusual case, in which a Marjolin's ulcer presented in the natal cleft 45 years after the initial burn injury. Its presentation mimicked that of an anal canal carcinoma, although detailed workup, which included computed tomography (CT) scan revealed this growth to be separate from the anal canal, albeit in close association. This is an extremely rare site and the study illustrates that squamous cell carcinoma can mimic anal carcinoma unless carefully examined.

Rapid onset of myelodysplastic syndrome after treatment for anal cancer: A case report.

Rapid onset of myelodysplastic syndrome after treatment for anal cancer: A case report.

A Lesion on Rectal Retroflexion

Question: A 77-year-old woman presented with chronic constipation and intermittent episodes of painless hematochezia related to “hemorrhoids.” Prior colonoscopies were unrevealing. On digital rectal examination, no lesions were palpated. A colonoscopy was performed, which was unremarkable; there were no lesions seen as the colonoscope was withdrawn through the rectum and anal canal area. However, retroflexion of the instrument within the rectum demonstrated a distal rectal lesion (Figure A). It was unclear if this polypoid lesion was originating from the rectum or the anal canal. Given its proximity to the dentate line, it was biopsied (Figure B). What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Figure B shows the histopathology of Bowen's disease (also known as squamous cell carcinoma in situ) with atypical squamous cells which have abundant eosinophilic cytoplasm and large nuclei. Carcinoma in situ is a noninvasive lesion defined as having malignant cells that have not penetrated the basement membrane. The condition was originally described by John T. Bowen in 1912.1Bowen J.T. Precancerous dermatoses: a study of two cases of chronic atypical epithelial proliferation.J Cutan Dis Syph. 1912; 30: 241-255Google Scholar Bowen's disease is used to refer to a dysplastic condition of the anal canal epithelium. However, the term “Bowen's disease” is not clearly defined in the literature and other terms used to describe dysplastic anal canal lesions include anal squamous intraepithelial lesions or anal intraepithelial neoplasia. As in our patient, anal bleeding is the most common symptom of anal canal carcinoma.2Ryan D.P. Compton C.C. Mayer R.J. Carcinoma of the anal canal.N Engl J Med. 2000; 342: 792Crossref PubMed Scopus (358) Google Scholar There is disagreement regarding the best treatment for Bowen's disease.3Chang G.J. Welton M.L. Anal neoplasia.Semin Colon Rectal Surg. 2003; 14: 111Abstract Full Text Full Text PDF Scopus (11) Google Scholar Our patient was treated as invasive T2 anal cell carcinoma with combined radiation and chemotherapy, because it was suspected that there was likely an invasive component given that the lesion involved one third of the circumference of the anorectal ring. One year later, she has no evidence of residual or recurrent disease. This case highlights 2 important points. First, painless rectal bleeding from anal squamous cell carcinoma can mimic hemorrhoidal bleeding and episodes of painless rectal outlet bleeding should not be attributed to internal hemorrhoids without an anoscopic examination. Second, this lesion would have been missed if the retroflexion maneuver had not been performed, thus illustrating the usefulness of rectal retroflexion in detecting neoplastic lesions.

Plan comparison of volumetric-modulated arc therapy (RapidArc) and conventional intensity-modulated radiation therapy (IMRT) in anal canal cancer

BackgroundTo compare volumetric-modulated arc therapy (RapidArc) plans with conventional intensity-modulated radiation therapy (IMRT) plans in anal canal cancers.MethodsTen patients with anal canal carcinoma previously treated with IMRT in our institution were selected for this study. For each patient, three plans were generated with the planning CT scan: one using a fixed beam IMRT, and two plans using the RapidArc technique: a single (RA1) and a double (RA2) modulated arc therapy. The treatment plan was designed to deliver in one process with simultaneous integrated boost (SIB) a dose of 59.4 Gy to the planning target volume (PTV2) based on the gross disease in a 1.8 Gy-daily fraction, 5 days a week. At the same time, the subclinical disease (PTV1) was planned to receive 49.5 Gy in a 1.5 Gy-daily fraction. Plans were normalized to 99% of the PTV2 that received 95% of the prescribed dose. Planning objectives were 95% of the PTV1 will receive 95% of the prescribed dose and no more than 2% of the PTV will receive more than 107%. Dose-volume histograms (DVH) for the target volume and the organs at risk (bowel tract, bladder, iliac crests, femoral heads, genitalia/perineum, and healthy tissue) were compared for these different techniques. Monitor units (MU) and delivery treatment time were also reported.ResultsAll plans achieved fulfilled objectives. Both IMRT and RA2 resulted in superior coverage of PTV than RA1 that was slightly inferior for conformity and homogeneity (p < 0.05).Conformity index (CI95%) for the PTV2 was 1.15 ± 0.15 (RA2), 1.28 ± 0.22 (IMRT), and 1.79 ± 0.5 (RA1). Homogeneity (D5% - D95%) for PTV2 was 3.21 ± 1.16 Gy (RA2), 2.98 ± 0.7 Gy (IMRT), and 4.3 ± 1.3 Gy (RA1). RapidArc showed to be superior to IMRT in terms of organ at risk sparing. For bowel tract, the mean dose was reduced of 4 Gy by RA2 compared to IMRT. Similar trends were observed for bladder, femoral heads, and genitalia. The DVH of iliac crests and healthy tissue resulted in comparable sparing for the low doses (V10 and V20). Compared to IMRT, mean MUs for each fraction was significantly reduced with RapidArc (p = 0.0002) and the treatment time was reduced by a 6-fold extent.ConclusionFor patients suffering from anal canal cancer, RapidArc with 2 arcs was able to deliver equivalent treatment plan to IMRT in terms of PTV coverage. It provided a better organ at risk sparing and significant reductions of MU and treatment time per fraction.