The role of radiation therapy in the treatment of anal carcinoma: Techniques and current recommendations

Background: In view of the results of surgery for anal cancer the treatment of choice is radiation therapy with or without chemotherapy. Methods: From 1987 until 1990 a total of 14 patients have undergone primarily conservative treatment at the University Clinic of Radiology in Graz. 10 patients were treated with a split-course technique of external beam and interstitial radiation over a period of 7 weeks. In 4 patients a similar radiation protocol, omitting the second implantation, was combined with 2 courses of 5-Fluorouracil (5-FU) and Mitomycin C (MMC). Results: Permanent tumor control was achieved in 8/10 cases after radiotherapy only, with sphincter preservation in 7 patients. Combined chemo-radiotherapy yielded complete remission in 3/4 patients. All failures of therapy occurred in T3 tumors. Conclusions: At present the best results in terms of tumor response and toxicity are achieved by 5-FU and MMC given synchronously with radiotherapy. Radiation is preferably applied according to a split-course protocol, as established by Papillon.