Anal carcinomas: new combined modality treatment approaches.

In the past, anal cancers were treated by abdominal-perineal resection with permanent colostomy. Radiotherapy was used only for inoperable patients or those with unresectable cancers. With improvements in the delivery of radiation, external radiotherapy, brachytherapy, or combinations of the two were used in patients with localized disease of less than 4 cm in size with results similar to surgical resection. Unfortunately, up to 25% of these patients developed severe necrosis necessitating permanent colostomy. During the past decade a considerable change in the treatment of these cancers occurred. Chemo-radiotherapy has made surgical resection unnecessary in the majority of patients. The primary treatment is now the combination of mitomycin-C and 5-fluorouracil (96-hour infusion), plus radiation (3,000 cGy).