A Regional Canadian Cancer Centre Experience with Combined Modality Organ Preservation Treatment in Anal Cancers

Background and aim: Anal cancer is a malignant phenomenon which is a distinct entity from the other colorectal malignancies. Local control and sphincter preservation are the two challenges of anal canal cancer treatment that physicians face. Methods and Materials: Population based historical cohort with confirmed histological diagnosis of anal canal or anal margin cancer treated with organ preservation approach such as chemo radiation from 19702006 registered with Saskatchewan Cancer Registry was evaluated. Data was collected on 152 patients; only fifty patients were eligible. Primary end points were colostomy free survival, disease free survival and overall survival. The influences of tumor AJCC stage, nodal stage, age, radiation dose on primary end points were also evaluated. Toxicities scored according to RTOG and late by LENT/SOMA scale. Results: Median age was 58 years (range 31-79 years).Thirty patients (60%) were under 60 years of age and 20 (40%) were above the age of 60 years. Mean follow up was 4.2 years (range 8-21 years). Overall 5 year survival was 53%, 5 year disease specific survival was 67% and 5 year colostomy free survival was 83%. AJCC stage grouping was the only risk factor that showed a statistically significant influence on disease free survival and overall survival. Conclusion: Combined radiochemotherapy for anal cancer is a very effective therapy. Advanced stage at presentation has an adverse effect on overall and disease free survival. However new chemotherapeutic drugs and IMRT based radiation should be thoroughly investigated.