CARCINOMAS OF THE ANAL-CANAL - ROLE OF RADIATION-THERAPY AND COMBINED CHEMOTHERAPY AND RADIATION-THERAPY

Carcinoma of the anal canal is a rare disease, more common in women than in men. The mean age distribution at presentation is about 60 years. The natural history is mainly loco-regional, distant metastases being uncommon. Histologically, most cancer are of the squamous cell type of different keratinization. The pre treatment evaluation is mainly performed by methodical clinical examination. There is no widely accepted staging system for these tumours. Three statistically significant prognostic factors are admitted : tumour size, regional nodal involvement and histological grade. The french school (Tenon, Institut Gustave Roussy, Institut Curie, Lyon) and the experience at the ''Princess Margaret Hospital'' at Toronto have shown that irradiation of these tumours is an adequate therapy. In Europe, irradiation has always played a more important role in the therapy of these tumours, than in North America where surgery was often prefered as the initial therapy. With the introduction of combined modality treatment, the use of pre-operative concomitant radiochemotherapy, in North America, has again changed the treatment policy towards a conservative radiotherapeutic approach. The present study analyses the modalities and the results from radiation therapy alone and the preliminary results from concomitant irradiation and chemotherapy.