Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer.
Renehan, Andrew G Saunders, Mark P Schofield, Philip F O'Dwyer, Sarah T
Renehan, Andrew G
Saunders, Mark P
Schofield, Philip F
O'Dwyer, Sarah T
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Abstract
BACKGROUND: Salvage surgery for anal cancer is usually reserved for local disease failure, but issues relating to the prediction of local failure and surgical outcome are ill defined. METHODS: Between 1988 and 2000, 254 patients with non-metastatic anal epidermoid carcinoma were treated at a regional cancer centre with radiotherapy (n = 127) or chemoradiotherapy (n = 127). RESULTS: There were 99 local disease failures (39.0 per cent), all but five occurring within 3 years of initial treatment. Increasing age (P < 0.001, Cox model), total radiation dose (P = 0.004) and tumour stage (P = 0.010) were independent predictors of local failure. The overall 3- and 5-year survival rates after local disease failure were 46 and 29 per cent; the corresponding rates after salvage surgery (73 patients) were 55 and 40 per cent. A positive resection margin was the strongest negative predictor of survival after salvage surgery (P = 0.008, log rank test). Of 52 patients treated before the routine consideration of primary plastic reconstruction, delayed perineal wound healing occurred in 22 (42 per cent). CONCLUSION: In the management of anal cancer, local disease failure is a major clinical problem requiring early detection followed by radical surgery, often accompanied by plastic reconstruction. By implication, these factors favour the centralization of treatment for this uncommon cancer to a multidisciplinary oncology team.
Description
Date
2005-05
Publisher
Collections
Keywords
Anus Cancer
Cancer
Cancer
Type
Article
Citation
Patterns of local disease failure and outcome after salvage surgery in patients with anal cancer. 2005, 92 (5):605-14 Br J Surg