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Abstract

This chapter will discuss the epidemiology, workup, staging, treatment recommendations, key studies, and radiation treatment techniques for anal cancer.

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References

  • Ajani JA, Winter KA, Gunderson LL, et al. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA. 2008;299(16):1914–21.

    Article  CAS  Google Scholar 

  • Bartelink H, Roelofsen F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol. 1997;15:2040–9.

    Article  CAS  Google Scholar 

  • Ben-Josef E, Moughan J, Ajani JA, et al. Impact of overall treatment time on survival and local control in patients with anal cancer: a pooled data analysis of Radiation Therapy Oncology Group trials 87-04 and 98-11. J Clin Oncol. 2010;28(34):5061–6.

    Article  Google Scholar 

  • Boman BM, Moertel CG, et al. Carcinoma of the anal canal. A clinical and pathological study of 188 cases. Cancer. 1984;54:114–25.

    Article  CAS  Google Scholar 

  • Call JA, Prendergast BM, Jensen LG, et al. Intensity-modulated radiation therapy for anal cancer: results from a multi-institutional retrospective cohort study. Am J Clin Oncol. 2016;39(1):8–12.

    Article  CAS  Google Scholar 

  • Cotter SE, Grigsby PW, Siegel BA, et al. FDG-PET/CT in the evaluation of anal carcinoma. Int J Radiat Oncol Biol Phys. 2006;65:720–5.

    Article  Google Scholar 

  • Cummings BJ, Keane TJ, O’Sullivan B, et al. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin-c. Int J Radiat Oncol Biol Phys. 1991;21(5):1115–25.

    Article  CAS  Google Scholar 

  • Deniaud-Alexandre E, Touboul E, Tiret E, et al. Results of definitive irradiation in a series of 305 epidermoid carcinomas of the anal canal. Int J Radiat Oncol Biol Phys. 2003;56(5):1259–73.

    Article  Google Scholar 

  • Ellenhorn JD, Enker WE, Quan SH. Salvage abdominoperineal resection following combined chemotherapy and radiotherapy for epidermoid carcinoma of the anus. Ann Surg Oncol. 1994;1:105–10.

    Article  CAS  Google Scholar 

  • Flam M, Madhu J, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a Phase III Randomized Intergroup Study. J Clin Oncol. 1996;14:2527–39.

    Article  CAS  Google Scholar 

  • Gerard JP, Ayzac L, et al. Treatment of anal canal carcinoma with high dose radiation therapy and concomitant fluorouracil-cisplatinum. Long-term results in 95 patients. Radiother Oncol. 1998;46(3):249–56.

    Article  CAS  Google Scholar 

  • Glynne-Jones R, Meadows H, Wan S, et al. Extra – a multicenter phase ii study of chemoradiation using a 5 day per week oral regimen of capecitabine and intravenous mitomycin c in anal cancer. Int J Radiat Oncol Biol Phys. 2008;72(1):119–26.

    Article  CAS  Google Scholar 

  • Glynne-Jones R, Sebag-Montefiore D, Meadows HM, et al. Best time to assess complete clinical response after chemoradiotherapy in squamous cell carcinoma of the anus (ACT II): a post-hoc analysis of randomised controlled phase 3 trial. Lancet Oncol. 2017;S1470-2045(17):30071–2.

    Google Scholar 

  • Greenall MJ, Quan HQ, Decosse JJ. Epidermoid cancer of the anus. Br J Surg. 1985;72:S97.

    Article  Google Scholar 

  • Gunderson LL, Winter KA, Ajani JA, et al. Long-term update of US GI intergroup RTOG 98-11 phase III trial for anal carcinoma: survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomycin versus fluorouracil/cisplatin. J Clin Oncol. 2012;30(35):4344–51.

    Article  CAS  Google Scholar 

  • Gunderson LL, Moughan J, Ajani JA, et al. Anal carcinoma: impact of TN category of disease on survival, disease relapse, and colostomy failure in US Gastrointestinal Intergroup RTOG 98-11 phase 3 trial. Int J Radiat Oncol Biol Phys. 2013;87(4):638–45.

    Article  Google Scholar 

  • Hatfield P, Cooper R, Sebag-Montefiore D. Involved-field, low-dose chemoradiotherapy for early-stage anal carcinoma. Int J Radiat Oncol Biol Phys. 2008;70(2):419–24.

    Article  CAS  Google Scholar 

  • Hoffman R, Welton ML, et al. The significance of pretreatment CD4 count on the outcome and treatment tolerance of HIV-positive pts with anal cancer. Int J Radiat Oncol Biol Phys. 1999;44:127–31.

    Article  CAS  Google Scholar 

  • Huang K, Haas-Kogan D, Weinberg V, et al. Higher radiation dose with a shorter treatment duration improves outcome for locally advanced carcinoma of anal canal. World J Gastroenterol. 2007;13(6):895–900.

    Article  Google Scholar 

  • James R, Glynne-Jones D, Meadows HM, et al. Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2 × 2 factorial trial. Lancet Oncol. 2013;14:516–24.

    Article  CAS  Google Scholar 

  • John M, Pajak T, et al. Dose escalation in chemoradiation for anal cancer: preliminary results of RTOG 92-08. Cancer J Sci Am. 1996;2(4):205.

    CAS  PubMed  Google Scholar 

  • Kachnic LA, Winter K, Myerson RJ, et al. RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys. 2013;86:27–33.

    Article  CAS  Google Scholar 

  • Koh WJ, Chiu M, Stelzer KJ, et al. Femoral vessel depth and the implications for groin node radiation. Int J Radiat Oncol Biol Phys. 1993;27:969–74.

    Article  CAS  Google Scholar 

  • Martenson JA, Gunderson LL. External radiation therapy without chemotherapy in the management of anal cancer. Cancer. 1993;71(5):1736–40.

    Article  Google Scholar 

  • Meropol NJ, Niedzwiecki D, Shank B, et al. Induction therapy for poor-prognosis anal canal carcinoma: a phase II study of the Cancer and Leukemia Group B (CALGB 9281). J Clin Oncol. 2008;26(19):3229–34.

    Article  CAS  Google Scholar 

  • Milano MT, Jani AB, Farrey KJ, et al. Intensity-modulated radiation therapy (IMRT) in the treatment of anal cancer: toxicity and clinical outcome. Int J Radiat Oncol Biol Phys. 2005;63:354–61.

    Article  Google Scholar 

  • Mistrangelo M, Pelosi E, Bellò M, et al. Role of positron emission tomography-computed tomography in the management of anal cancer. Int J RadiatOncolBiol Phys. 2012;84(1):66–72.

    Article  Google Scholar 

  • Moran M, Lund MW, Ahmad M, et al. Improved treatment of pelvis and inguinal nodes using modified segmental boost technique: dosimetric evaluation. Int J Radiat Oncol Biol Phys. 2004;59(5):1523–30.

    Article  Google Scholar 

  • Myerson RJ, et al. Elective clinical target volumes for conformal therapy in anorectal cancer: an Radiation Therapy Oncology Group consensus panel contouring atlas. Int J Radiat Oncol Biol Phys. 2008;74:824–30.

    Article  Google Scholar 

  • National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER). https://www.seer.cancer.gov/statfacts/html/anus.html. Accessed 5 Dec 2016.

  • National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology: Anal Carcinoma (Version 1.2017). https://www.nccn.org/professionals/physician_gls/pdf/anal.pdf. Accessed 5 Dec 2016.

  • Ng Y, Ying Kin NY, Pigneux J, et al. Our experience of conservative treatment of anal cancal carcinoma combining external irradiation and interstitial implants. Int J Radiat Oncol Biol Phys. 1988;14:253–9.

    Article  Google Scholar 

  • Northover J, Glynne-Jones R, Sebag-Montefiore D, et al. Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I). Br J Cancer. 2010;102:1123–8.

    Article  CAS  Google Scholar 

  • Oehler-Jänne C, Huguet F, Provencher S, et al. HIV-specific differences in outcome of squamous cell carcinoma of the anal canal: a multicentric cohort study of HIV-positive patients receiving highly active antiretroviral therapy. J Clin Oncol. 2008;26:2550–7.

    Article  Google Scholar 

  • Papagikos M, Crane CH, et al. Chemoradiation for adenocarcinoma of the anus. Int J Radiat Oncol Biol Phys. 2003;55:669–78.

    Article  Google Scholar 

  • Papillon J, Montbarbon JF. Epidermoid carcinoma of the anal canal. A series of 276 cases. Dis Colon Rectum. 1987;30:324–33.

    Article  CAS  Google Scholar 

  • Peiffert D, Bey P, Pernot M, et al. Conservative treatment by irradiation of epidermoid carcinomas of the anal margin. Int J Radiat Oncol Biol Phys. 1997;39:57–66.

    Article  CAS  Google Scholar 

  • Peiffert D, Tournier-Rangeard L, Gérard JP, et al. Induction chemotherapy and dose intensification of the radiation boost in locally advanced anal canal carcinoma: final analysis of the randomized UNICANCER ACCORD 03 trial. J Clin Oncol. 2012;30:1941–8.

    Article  CAS  Google Scholar 

  • Peixoto RD, Wan DD, Schellenberg D, et al. A comparison between 5-fluorouracil/mitomycin and capecitabine/mitomycin in combination with radiation for anal cancer. J Gastrointest Oncol. 2016;7:665–72.

    Article  Google Scholar 

  • Salama JK, Mell LK, Schomas DA, et al. Concurrent chemotherapy and intensity-modulated radiation therapy for anal canal cancer patients: a multicenter experience. J Clin Oncol. 2007;29:4851–6.

    Google Scholar 

  • Sandhu APS, Symonds RP, et al. Interstitial Iridium-192 implantation combined with external radiotherapy in anal cancer: ten yrs experience. Int J Radiat Oncol Biol Phys. 1998;40:575–81.

    Article  CAS  Google Scholar 

  • Schwarz JK, Siegel BA, Dehdashti F, et al. Tumor response and survival predicted by post-therapy FDG-PET/CT in anal cancer. Int J Radiat Oncol Biol Phys. 2008;71(1):180–6.

    Article  Google Scholar 

  • Trautmann TG, Zuger JH. Positron emission tomography for pretreatment staging and post-treatment evaluation in cancer of the anal canal. Mol Imaging Biol. 2005;7:309–13.

    Article  Google Scholar 

  • UKCCCR Anal Cancer Trial Working Party. Epidermoid anal cancer: results from the UKCCCR randomized trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. Lancet. 1996;348:1049–54.

    Article  Google Scholar 

  • Widder J, Kastenberger R, Fercher E, et al. Radiation dose associated with local control in advanced anal cancer: retrospective analysis of 129 patients. Radiother Oncol. 2008;87(3):367–75.

    Article  Google Scholar 

  • Winton Ed, Heriot AG, Ng M, et al.The impact of 18-fluorodeoxyglucose positron emission tomography on the staging, management and outcome of anal cancer. Br J Cancer. 2009;100(5):693–700.

    Article  Google Scholar 

  • White EC, Goldman K, Aleshin A, et al. Chemoradiotherapy for squamous cell carcinoma of the anal canal: comparison of one versus two cyclesmitomycin-C. Radiother Oncol. 2015;117(2):240–5.

    Article  Google Scholar 

  • White EC, Khodayari B, Erickson KT, et al. Comparison of toxicity and treatment outcomes in HIV-positive versus HIV-negative patients with squamous cell carcinoma of the anal canal. Am J Clin Oncol. 2017;40(4):386–92.

    Article  Google Scholar 

  • Wo JY, Hong TS, Callister MD, et al. Anal carcinoma. In: Gunderson LL, Tepper JE, editors. Clinical radiation oncology. 4th ed. Philadelphia: Churchill Livingstone; 2015. p. 1019–34.e4.

    Google Scholar 

  • Yeung R, McConnell Y, Roxin G, et al. One compared with two cycles of mitomycin C in chemoradiotherapy for anal cancer: analysis of outcomes and toxicity. Curr Oncol. 2014;21(3):e449–56. https://doi.org/10.3747/co.21.1903.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgment

The authors thank Amy Gillis MD and Gautam Prasad MD, PhD for their work on the prior edition of this chapter.

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Correspondence to Mekhail Anwar .

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Choi, S., Chung, H.T., Anwar, M. (2018). Anal Cancer. In: Hansen, E., Roach III, M. (eds) Handbook of Evidence-Based Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-62642-0_23

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  • DOI: https://doi.org/10.1007/978-3-319-62642-0_23

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