Сombined treatment of squamous-cell anal cancer

Since 1974 chemoradiation scheme proposed by Nigro remains the standard of care for squamous-cell anal cancer in most countries. Improvement of treatment results can be achieved by developing new treatment schemes including different radio- and chemosensitizers.

Methods. Results of treatment of 157 T1–4N0–2M0 squamous-cell anal cancer patients, which underwent treatment during 1990–2012 were analyzed. Patients were divided into 3 groups: group A received hyperfractionated radiotherapy (RT) single dose 1.2 Gy bid, total dose 40–44 Gy with 3–5 sessions of local hyperthermia (HT) during treatment; group B had similar RT + HT scheme with addition of chemotherapy (CT) with cisplatin 20 mg/m2 in days 1, 3 weeks 1–4 and bleomycin 15 mg in days 2, 4 weeks 1–4; group C had RT with single dose 2 Gy, same total dose, HT and CT as in group B and additionally received metronidazole 10 g/m2 per rectum in a polymeric composition. Two weeks after 1st treatment stage a second course of RT was carried out 20–24 Gy in 2 Gy fractions in all patient groups.

Results. Sphincter-sparing treatment was carried out in 11 (50 %), 71 (80.68 %) and 44 (93.62 %) in groups A, B and C accordingly. Three year overall survival (OS) was 60.0; 82.4; 96.4 %; 3-year disease-free survival (DFS) 36.6; 69.8 and 76.3 % accordingly.

Conclusions. In our study combined treatment using radiosensitization allow to improve sphincter preservation rate to 93 %, improve OS and DFS for squamous-cell anal cancer patients.

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