[Prognosis of epidermoid anal carcinoma regression after conservative treatment]

Abstract

The prospective study was concerned with definition of the clinical and therapeutic factors behind poor response of anal cancer to radio- (RT) or chemoradiotherapy (CRT). Out of 64 female and 8 male patients at the mean age of 57 (33-81), thirty six had split-course of 60-65 Gy (RT), twenty--60-65 Gy, 5-FU and mitomycin C (CRT) and eighteen--up to 55-65 Gy (1.5 Gy--session 1, 1.0 Gy--session 2) (hyper-fractionated RT) plus 5-FU, for squamous cell anal carcinoma. There was no endorectal ultrasound evidence of perirectal lymph node involvement (uN0): T1-2uN-M0 (n=46), T3-4uN0M0 (n=11), uN1 or N2-3 (groin or endorectal ultrasound: T1-2uN-M0 (n=46), T3-4uN0M0 (n=11), uN1 or N2-3 (groin metastases) were detected in 7 patients: T1-2uN1-2M0 (n=7), T3-4N1-3M0 (n=10). Endorectal ultrasound staging (ERUS) used a linear 7.5 MHz transducer. The uTNM system was devised on the basis of tumor invasion parameters. There were no tumors confined to the subendothelial layer of the anal canal (uT1); 24 (32.4%) tumors were confined to the internal anal sphincter (uT2); 19 (25.7%) invaded the external anal sphincter (uT3) and 31 (41.9%)--levator ani (uT4). All carcinomas T4 (n=9) corresponded to the uT4 category. Only T-stage and tumor invasion (uT) proved significant prognostic variables. Complete response of T1-2 was 79.2%, T3-4--33.3% (p=0.0003); uT2--95.8%, uT3--68.4%, and uT4--41.9% (except T4) (p=0.0001). In multivariate logistic analysis, uT alone appeared an independent variable (p=0.015). ERUS uTNM staging is more effective in prognosis for RT and CRT and, therefore, should be recommended for preliminary management of epidermoid anal carcinoma.