Combined chemotherapy and radiotherapy for carcinomas of the anus

Article Abstract:

Squamous cell carcinoma of the anus has traditionally been treated with abdominoperineal resection (APR), removal of tissue in the region of the cancer, which is a drastic surgical procedure. A new approach, chemotherapy combined with radiotherapy (CT-RT), is reported to effectively control the cancer, and the results of 14 patients with cancer of the anal canal and dentate line who were treated using this approach are reported. Small tumors were removed down to the level of the anal canal muscle, and biopsies were obtained of larger tumors. If enlarged, lymph nodes in nearby regions were removed and evaluated for metastasis (spread). The patients received CT-RT treatment, using mitomycin C and 5-fluorouracil as the chemotherapeutic agents. Six weeks after CT-RT ended, a biopsy was again performed. The results showed no signs of local cancer in 13 patients (one died of a blood clot before this point was reached). Of the initial group, four patients died, two from the cancer for which they were treated. The remaining patients are alive, representing various survival times. Four patients had metastasis to lymph nodes; one of these individuals died. At this point, the average survival for the group is 21 months. One problem in interpreting the results of treatment for anal cancer is caused by varying terminologies for variant forms, and studies are cited that illustrate this point. Indications that recurrence after this treatment tends to be distant, rather than local, must be considered by the clinician in follow-up care. Overall, the findings indicate that CT-RT is a successful approach for the local control of anal cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Prognosis, Cancer, Cancer treatment, Excision (Surgery)

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Multimodal therapy in locally advanced breast carcinoma

Article Abstract:

There has been significant improvement in the treatment of patients with locally advanced breast cancer. These patients have historically had a high rate of cancer recurrence and poor survival as a result of uncontrolled metastases that is not controlled by local therapy alone (surgery and radiation). During the 1980's multimodal treatment with induction chemotherapy, surgery, and radiotherapy produced a dramatic initial response. However, there is little data on long-term survival of these patients. A study was undertaken of 849 patients treated for breast cancer between 1975 and 1984; 125 patients (14 percent) had advanced disease, with 34 patients (4 percent) with untreated locally advanced disease without detected metastasis in areas other than the breast. Of these 34 patients, 17 (Group A) were treated by radiotherapy and chemotherapy between 1975 and 1979. In the subsequent five-year period (1980 to 1984), the other 17 patients (Group B) were treated with induction chemotherapy followed by mastectomy (removal of the breast) and further chemotherapy. Follow-up ranged from 4 to 15 years. Local disease control rates were similar in both groups; 76 percent. Group A patients had an average survival of 15 months; only one patient survived five years. In Group B, the average survival was 56 months; nine patients were alive from 40 and 76 months, and seven patients survived five years. These results suggest that multimodal therapy with induction chemotherapy improves survival for breast cancer patients and delays metastasis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Breast cancer

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Squamous cell carcinoma of the anal canal

Article Abstract:

Squamous cell cancer of the anal canal is an uncommon type of anal cancer. Although in the past this cancer was most often found in the elderly, today it occurs more often in young patients, particularly young men. Radical surgical treatment (abdominoperineal resection) has been the standard treatment, but recent evidence suggests that external beam radiotherapy may be equally effective for squamous cell cancer of the anal canal. Some reports have suggested that chemoradiation (combination of chemotherapy and radiation) is beneficial in the treatment of this cancer. To further explore the effectiveness of this approach, 33 patients with squamous cell carcinoma of the anal canal were treated with chemoradiation. The group consisted of 24 women and 9 men (average age 63 years). Treatment resulted in complete tumor regression in 29 patients (88 percent); only one of the 29 patients later developed cancer recurrence. Ten patients with tumor regression had biopsies of the previous cancer site three months after chemoradiation treatment; cancer was not found in any of the tissue specimens. Two to 10 years after treatment (average 4 years), 26 patients (79 percent) are alive and free of cancer. Two patients died from other causes, four from cancer and one is alive with cancer. There were no treatment related deaths. These findings suggest that radical surgery is no longer necessary to treat squamous cell cancer of the anus; chemoradiation appears to be equally effective. (Consumer Summary produced by Reliance Medical Information, Inc.)

Squamous cell carcinoma

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