Stage II anal cancer was formerly treated with abdominoperineal resection. Current sphincter-sparing therapies include wide local excision for small tumors of the perianal skin or anal margin, or definitive chemoradiation (fluorouracil and mitomycin) for cancers of the anal canal. Salvage chemotherapy (fluorouracil with cisplatin plus a radiation boost) may avoid permanent colostomy in patients with residual tumor following initial nonoperative therapy. Radical resection is reserved for patients with incomplete responses or recurrent disease. Therefore, continued surveillance with rectal examination every 3 months for the first 2 years and endoscopy/biopsy when indicated after completion of sphincter-preserving therapy is important.
Small tumors of the perianal skin or anal margin not involving the anal sphincter may be adequately treated with local resection.
All other stage II cancers of the anal canal that involve the anal sphincter or are too large for complete local excision are treated with external-beam radiation therapy plus chemotherapy as evidenced in the RTOG-8314 trial, for example.[2,3,4,5,6,7,8]
Chemotherapy with fluorouracil and mitomycin combined with primary radiation therapy appears to be more effective than radiation therapy alone. The optimal dose of radiation with concurrent chemotherapy was studied, as seen in the RTOG-9811 and RTOG-9208 trials, for example.[10,11]
Selected tumors are also suitable for interstitial radiation therapy.[3,12]
Radical resection is reserved for continued residual or recurrent cancer in the anal canal after nonoperative therapy.
Alternately, salvage chemotherapy with fluorouracil and cisplatin combined with a radiation boost may avoid a permanent colostomy in selected patients with small amounts of residual tumor following initial nonoperative therapy.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II anal cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
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