Management of persistent anal canal carcinoma after combined-modality therapy: a clinical review

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.

Surgery Is an Effective Option after Failure of Chemoradiation in Cancers of the Anal Canal and Anal Margin

“…Furthermore, the wound disruption rate appears to be higher when radical surgery is performed within 90 days after CRT [16] . This reinforces the theory that in cases of immediate persistent disease after CRT (especially after the first sequence), continuation of a close follow-up of the patient for a minimum of 6 months after the completion of radiation is reasonable [27] . In cases of complete response after CRT, a multidisciplinary team should implement a follow-up that spans the lifetime of the patient (as 1 of our patients experienced recurrence nearly 9 years after CRT) in order to detect late recurrence (in 6% of the cases in our study) or a second cancer.…”

Definitive Chemoradiotherapy for Anal Carcinoma: Long-Term Results Based on Consistent Time-to-Event Endpoints

“…The prognostic value of the rapidity of the clinical response to therapy has been largely proven in anal carcinoma [12,15,16] . For instance, Chapet et al [15] reported on 252 patients with anal canal cancer.…”

“…Following definitive CRT, patients were reevaluated by serial digital anorectal exploration, inguinal node palpation and anoscopy at 6-week intervals. Patients with clinical suspicion of persistent disease at 6 months underwent a biopsy, and consideration of abdominoperineal resection (APR) was recommended [12] . In case of complete clinical response, the patient continues with a regular follow-up schedule, including complete physical examination and endoanal ultrasound at 3 monthly intervals for the additional 2 years and every 6 months for subsequent years.…”

Anal Canal Carcinoma in a Child With Disorders of Sex Development

“…Potentially curative radiochemotherapy with 5-fluorouracil and mitomycin C is considered to be the gold standard in the treatment of anal cancer. [19,20] Surgery is generally reserved for persistent or recurrent cases. In our case, chemotherapy was with held due to the renal malfunction.…”