Anal Canal Carcinoma: Experience from a Single Korean Institution

다국어 초록 (Multilingual Abstract)

Purpose: The clinical features, treatment modality approaches in clinical practice, and prognostic factors for anal canal carcinoma patients were retrospectively analyzed. Materials and Methods: Between October 1994 and December 2005, 50 patients with anal canal cancer were treated at Samsung Medical Center, Seoul, Korea. Results: After a median follow up of 37.8 months (range, 6.6-136.1 months), the 5-year and 10-year survival rates for the 38 patients with early and locally advanced squamous and cloacogenic carcinoma (squamous cell carcinoma and cloacogenic carcinoma) were 74.8% and 66.5%, respectively. The 5-year survival and disease-free survival rates (DFS) of the 31 patients who received chemoradiation therapy (CRT) were 83.6% and 74.3%, respectively. The overall and DFS could not be determined for the adenocarcinoma group due to the small number of cases (n=8). Univariate analysis showed that tumor size (p=0.04) and inguinal node status (p=0.04) significantly influenced patient survival in patients with squamous cell and cloacogenic carcinomas. Furthermore, univariate analysis also showed that, inguinal node status influenced patient survival in the adenocarcinoma group. Multivariate analysis showed that inguinal node metastasis is a single independent prognostic variable for survival (p=0.04) in patients with squamous cell and cloacogenic carcinomas. Conclusion: Combined CRT has been adopted as standard treatment with outcomes that are comparable to those reported in randomized clinical trials. Due to the rarity and complexity of anal canal carcinoma, interdepartmental cooperation is required for disease treatment. Thus, proper treatment of patients should incorporate a team-approach and should be available to as many patients as possible.

참고문헌 (Reference)

1 Whiteford MH, "The evolving treatment of anal cancer: How are we doing?" 136 : 886-891, 2001

2 Myerson RJ, "The National Cancer Data Base report on carcinoma of the anus" 80 : 805-815, 1997

3 Pintor MP, "Squamous cell carcinoma of the anus at one hospital from 1948 to 1984" 806-10, brjsurg1989;76

4 Flam M, "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" 14 : 2527-2739, 1996

5 Cummings B, "Results and toxicity of the treatment of anal canal carcinoma by radiation therapy or radiation therapy and chemotherapy" 2062-8,

6 Touboul E, "Radiotherapy of carcinomas of the anal canal. Tenon Hospital experience" 7 : 91S-99S, 2003

7 Goldstone SE, "High prevalence of anal squamous intraepithelial lesions and squamous-cell carcinoma in men who have sex with men as seen in a surgical practice" 44 : 690-698, 2001

8 "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" 348 : 1049-1054, 1996

9 Nilsson PJ, "Epidermoid anal cancer: a review of a population-based series of 308 consecutive patients treated according to prospective protocols" 61 : 92-102, 2005

10 Bartelink H, "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" 15 : 2040-2049, 1997

11 Nigro ND, "Combined therapy for cancer of the anal canal" 709-11, 1974

12 Nigro ND, "Combined therapy for cancer of the anal canal" 354-6,

13 "Combined chemotherapy- radiotherapy of anal cancer" 1221-3,

14 Hung A, "Cisplatin-based combined modality therapy for anal carcinoma: a wider therapeutic index" 97 : 1195-1202, 2003

15 Karlsen KO, "Chemotherapy and radiation therapy for anal carcinoma" 2462-6,

16 Rich TA, "Chemoradiation therapy for anal cancer radiation plus continuous infusion of 5-fluorouracil with or without cisplatin" 209-15, radiotheroncol1993;27

17 Nielsen OV, "Carcinomas of the anorectal region of extramucosal origin with special reference to the anal ducts" 299-305, actachirscand1973;139

18 Esiashvili N, "Carcinoma of the anus strategies in management" 7 : 188-199, 2002

19 Wong S, "Carcinoma of the anal canal: a local experience and review of the literature" 74 : 541-546, 2004

20 Clark MA, "Cancer of the anal canal" 5 : 149-157, 2004

21 Palefsky JM, "Anal squamous intraepithelial lesions in HIV-positive and HIV-negative homosexual and bisexual men: prevalence and risk factors" 17 : 320-326, 1998

22 American Joint Committee on Cancer, "Ajcc Cancer Staging Manual. 6th ed." New York: Springer-Verlag 61-, 2002