Skip to main content

Advertisement

SpringerLink
Log in

Anal canal squamous cell cancer: are surgical alternatives to chemoradiation just as effective?

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

A Correction to this article was published on 13 March 2018

This article has been updated

Abstract

Purpose

The purpose of this paper is to study long-term oncologic outcomes after different treatment strategies for anal canal cancer (SCAC).

Methods

Patients with SCAC (2004–2013) were identified from Surveillance, Epidemiology, and End Results (SEER) database. Patients undergoing radiation (RT) were compared to those undergoing local excision (LE), abdominoperineal resection (APR), and abdominoperineal resection after radiation (RT + APR). Overall survival (OS) and cancer-specific survival (CSS) data were evaluated using Kaplan-Meier and Cox regression.

Results

Two thousand seven hundred and seventy-two (83.8%) patients underwent RT, 382 (11.6%) LE, 77 (2.3%) APR, 76 (2.3%) RT + APR. Median age for the four groups was 60, 57, 64, and 56 years and 32, 49.7, 53.2, and 39.5% were male, respectively, while median tumor size was 4.4, 2.6, 5.3, and 5.5 cm, respectively. Five-year OS of RT, LE, APR, and RT + APR groups was 63.7, 79.6, 25.8, and 41.8% while CSS was 79.6, 92.5, 75.6, and 58.8%, respectively, (p < 0.001). Adjusted hazard ratios for OS for LE, APR, and RT + APR with RT as reference were 1.007 (0.702-1.444), 2.311 (1.367-3.906), and 2.072 (1.016-4.228), respectively.

Conclusion

These data suggest that APR does not provide better outcomes in treatment of SCAC. Chemoradiation remains the gold standard treatment for majority of patients. Local excision is associated with favorable outcomes in some circumstances.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Change history

  • 13 March 2018

    One of the author’s middle name of this article was incorrectly published as “Emmanouil E. Pappou.” This is now presented correctly in this article as “Emmanouil P. Pappou.”

References

  1. Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65(1):5–29. https://doi.org/10.3322/caac.21254

    Article  PubMed  Google Scholar 

  2. Daling JR, Madeleine MM, Johnson LG, Schwartz SM, Shera KA, Wurscher MA, Carter JJ, Porter PL, Galloway DA, McDougall JK (2004) Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer 101(2):270–280. https://doi.org/10.1002/cncr.20365

    Article  PubMed  Google Scholar 

  3. Joseph DA, Miller JW, Wu X, Chen VW, Morris CR, Goodman MT, Villalon-Gomez JM, Williams MA, Cress RD (2008) Understanding the burden of human papillomavirus-associated anal cancers in the US. Cancer 113(10 Suppl):2892–2900. https://doi.org/10.1002/cncr.23744

    Article  PubMed  PubMed Central  Google Scholar 

  4. DALBY JE, POINTON RS (1961) The treatment of anal carcinoma by interstitial irradiation. Am J Roentgenol Radium Therapy, Nucl Med 85:515–520

    CAS  Google Scholar 

  5. López Guerra JL, Lozano AJ, Pera J, Gutiérrez C, Cambray M, Ferrer F, Guedea F (2011) Twenty-year experience in the management of squamous cell anal canal carcinoma with interstitial brachytherapy. Clin Transl Oncol 13(7):472–479. https://doi.org/10.1007/s12094-011-0684-z

    Article  PubMed  Google Scholar 

  6. Hannoun-Levi JM, Ortholan C, Resbeut M, Teissier E, Ronchin P, Cowen D, Zaccariotto A, Bénézery K, François E, Salem N, Ellis S, Azria D, Gerard JP (2011) High-dose split-course radiation therapy for anal cancer: outcome analysis regarding the boost strategy (CORS-03 study). Int J Radiat Oncol Biol Phys 80(3):712–720. https://doi.org/10.1016/j.ijrobp.2010.02.055

    Article  PubMed  Google Scholar 

  7. (1996) Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 348(9034):1049–54

  8. Roelofsen F, Bartelink H (1998) Combined modality treatment of anal carcinoma. Oncologist 3(6):413–418

    CAS  PubMed  Google Scholar 

  9. Sato H, Koh PK, Bartolo DC (2005) Management of anal canal cancer. Dis Colon Rectum 48(6):1301–1315. https://doi.org/10.1007/s10350-004-0934-z

    Article  PubMed  Google Scholar 

  10. Clark J, Petrelli N, Herrera L, Mittelman A (1986) Epidermoid carcinoma of the anal canal. Cancer 57(2):400–406. https://doi.org/10.1002/1097-0142(19860115)57:2<400::AID-CNCR2820570237>3.0.CO;2-T

    Article  CAS  PubMed  Google Scholar 

  11. Fuchshuber PR, Rodriguez-Bigas M, Weber T, Petrelli NJ (1997) Anal canal and perianal epidermoid cancers. J Am Coll Surg 185(5):494–505. https://doi.org/10.1016/S1072-7515(97)00094-X

    Article  CAS  PubMed  Google Scholar 

  12. Berry JM, Jay N, Hernandez A, Darragh TM, Palefsky JM (2013) 3. Outcome of excision of early invasive squamous carcinomas of the anal canal and perianus. Sex Health 10(6):571–571. https://doi.org/10.1071/SHv10n6ab3

    Article  Google Scholar 

  13. Ortholan C, Ramaioli A, Peiffert D, Lusinchi A, Romestaing P, Chauveinc L, Touboul E, Peignaux K, Bruna A, de la Roche G, Lagrange JL, Alzieu C, Gerard JP (2005) Anal canal carcinoma: early-stage tumors < or =10 mm (T1 or Tis): therapeutic options and original pattern of local failure after radiotherapy. Int J Radiat Oncol Biol Phys 62(2):479–485. https://doi.org/10.1016/j.ijrobp.2004.09.060

    Article  PubMed  Google Scholar 

  14. Steele SR, Varma MG, Melton GB, Ross HM, Rafferty JF, Buie WD, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons (2012) Practice parameters for anal squamous neoplasms. Dis Colon Rectum 55(7):735–749. https://doi.org/10.1097/DCR.0b013e318255815e

    Article  PubMed  Google Scholar 

  15. Benson AB et al (2012) Anal Carcinoma, Version 2.2012: featured updates to the NCCN guidelines. J Natl Compr Cancer Netw 10(4):449–454. https://doi.org/10.6004/jnccn.2012.0046

    Article  Google Scholar 

  16. Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, Halverson AL (2008) Squamous cell carcinoma of the anal canal: utilization and outcomes of recommended treatment in the United States. Ann Surg Oncol 15(7):1948–1958. https://doi.org/10.1245/s10434-008-9905-2

    Article  PubMed  Google Scholar 

  17. Johnson LG, Madeleine MM, Newcomer LM, Schwartz SM, Daling JR (2004) Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973–2000. Cancer 101(2):281–288. https://doi.org/10.1002/cncr.20364

    Article  PubMed  Google Scholar 

  18. Bilimoria KY, Bentrem DJ, Rock CE, Stewart AK, Ko CY, Halverson A (2009) Outcomes and prognostic factors for squamous-cell carcinoma of the anal canal: analysis of patients from the National Cancer Data Base. Dis Colon Rectum 52(4):624–631. https://doi.org/10.1007/DCR.0b013e31819eb7f0

    Article  PubMed  Google Scholar 

  19. Grulich AE, Poynten IM, Machalek DA, Jin F, Templeton DJ, Hillman RJ (2012) The epidemiology of anal cancer. Sex Health 9(6):504–508. https://doi.org/10.1071/SH12070

    Article  PubMed  Google Scholar 

  20. Gilshtein H, Khoury W (2015) Surgical management of anal cancer. Minerva Chir 70(2):141–145

    CAS  PubMed  Google Scholar 

  21. Flejou JF (2015) An update on anal neoplasia. Histopathology 66(1):147–160. https://doi.org/10.1111/his.12574

    Article  PubMed  Google Scholar 

  22. Szmulowicz UM, Wu JS (2012) Squamous cell carcinoma of the anal canal: a review of the aetiology, presentation, staging, prognosis and methods available for treatment. Sex Health 9(6):593–609. https://doi.org/10.1071/SH12010

    Article  PubMed  Google Scholar 

  23. Boman BM, Moertel CG, O'Connell MJ, Scott M, Weiland LH, Beart RW, Gunderson LL, Spencer RJ (1984) Carcinoma of the anal canal. A clinical and pathologic study of 188 cases. Cancer 54(1):114–125. https://doi.org/10.1002/1097-0142(19840701)54:1<114::AID-CNCR2820540124>3.0.CO;2-P

    Article  CAS  PubMed  Google Scholar 

  24. Stearns MW Jr, Macher C, Ernberg SS, Dodruff J, Attiyeh F (1980) Cancer of the anal canal. Curr Probl Cancer 4(12):1–44. https://doi.org/10.1016/S0147-0272(80)80015-8

    Article  PubMed  Google Scholar 

  25. Beahrs OH, Wilson SM (1976) Carcinoma of the anus. Ann Surg 184(4):422–428. https://doi.org/10.1097/00000658-197610000-00004

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Klotz RG, Pamukcoglu T, Souilliard DH (1967) Transitional cloacogenic carcinoma of the anal canal. Clinicopathologic study of three hundred seventy-three cases. Cancer 20(10):1727–1745. https://doi.org/10.1002/1097-0142(196710)20:10<1727::AID-CNCR2820201024>3.0.CO;2-1

    Article  PubMed  Google Scholar 

  27. Greenall MJ, Quan SH, Urmacher C, DeCosse JJ (1985) Treatment of epidermoid carcinoma of the anal canal. Surg Gynecol Obstet 161(6):509–517

    CAS  PubMed  Google Scholar 

  28. Honda K, Usui Y, Denno R, Moriyama Y, Naito M, Satou B (2014) Local excision of T1b anal canal cancer—a case report. Gan To Kagaku Ryoho 41(12):1863–1865

    PubMed  Google Scholar 

  29. Young SC, Solomon MJ, Hruby G, Frizelle FA (2009) Review of 120 anal cancer patients. Color Dis 11(9):909–914. https://doi.org/10.1111/j.1463-1318.2008.01723.x

    Article  CAS  Google Scholar 

  30. Simpson S, Turner R (2012) Four decades of anal cancer in Tasmania, Australia: what do the case data tell us? Sex Health 9(3):213–219. https://doi.org/10.1071/SH11002

    Article  PubMed  Google Scholar 

  31. Klas JV, Rothenberger DA, Wong WD, Madoff RD (1999) Malignant tumors of the anal canal: the spectrum of disease, treatment, and outcomes. Cancer 85(8):1686–1693. https://doi.org/10.1002/(SICI)1097-0142(19990415)85:8<1686::AID-CNCR7>3.0.CO;2-7

    Article  CAS  PubMed  Google Scholar 

  32. Harlan LC, Hankey BF (2003) The surveillance, epidemiology, and end-results program database as a resource for conducting descriptive epidemiologic and clinical studies. J Clin Oncol 21(12):2232–2233. https://doi.org/10.1200/JCO.2003.94.023

    Article  PubMed  Google Scholar 

  33. Levine MN, Julian JA (2008) Registries that show efficacy: good, but not good enough. J Clin Oncol 26(33):5316–5319. https://doi.org/10.1200/JCO.2008.18.3996

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, Suite 837, 171 Fort Washington Ave, New York, NY, 10032, USA

    Kunal Suradkar, Emmanouil E. Pappou, Steven A. Lee-Kong, Daniel L. Feingold & Ravi P. Kiran

Authors
  1. Kunal Suradkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emmanouil E. Pappou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven A. Lee-Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel L. Feingold
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ravi P. Kiran
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ravi P. Kiran.

Ethics declarations

This study has been approved by the NewYork Presbyterian Hospital Institutional Review Board.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

SEER is a public access data, and a Data User agreement with National Cancer Institute was provided by the research team.

Additional information

A correction to this article is available online at https://doi.org/10.1007/s00384-018-3000-3.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Suradkar, K., Pappou, E.E., Lee-Kong, S.A. et al. Anal canal squamous cell cancer: are surgical alternatives to chemoradiation just as effective?. Int J Colorectal Dis 33, 181–187 (2018). https://doi.org/10.1007/s00384-017-2938-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-017-2938-x

Keywords

Search

Navigation