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Surgical Salvage Therapy is Effective Treatment for Patients with Rectal Cancer that Relapse Locally after Initial Sphincter-Conserving Treatment

Surgical Salvage Therapy is Effective Treatment for Patients with Rectal Cancer that Relapse Locally after Initial Sphincter-Conserving Treatment The standard of care for most patients with anal cancer is now initial treatment with radiation or chemoradiotherapy, with the aim of preserving the anus and allowing sphincter function. With this approach, approximately 60-90% of patients can expect to have the cancer eradicated. The majority of these patients will be cured and continue to have a functioning anus. A portion of patients undergoing this initial treatment will, however, have recurrence of the cancer. If the cancer recurs locally, without the development of distant metastases, the patient then needs to undergo radical surgery in order to “salvage” a second chance of being cured. There has been a paucity of data on how well patients do after this kind of salvage surgery following initial sphincter-preserving treatment. In a recent publication, doctors from the Geneva University Hospital, Switzerland, analyzed their 20-year experience in treating anal cancer with sphincter-preserving techniques. Approximately 20% of the patients failed locally. Two thirds of the patients failing locally had no evidence of metastases and so were still potentially curable. The surgical salvage treatment consisted mainly of abdominoperineal resections in which the tumor and anus are surgically removed in one piece. Of this group of patients, approximately half continue to enjoy freedom from recurrence at 5 years and, in all likelihood, are cured. This study reaffirms the validity of sphincter-preservation as the initial treatment for anal cancer. A good proportion of patients who fail this initial treatment are still salvageable by surgery. Future efforts will be directed at further improving the cure rate with the initial treatment, as well as strategies to detect recurrence at an early stage when surgical salvage is still possible. ( Cancer , Vol 86, No 3, pp 405-409, 1999)

Intensive Chemotherapy and Radiation Therapy Combo May Improve Outcomes for Persons with Cancer of the Anus

Intensive Chemotherapy and Radiation Therapy Combo May Improve Outcomes for Persons with Cancer of the Anus Persons who have cancers of the anus that have spread to the nearby lymph nodes or are large in size may require more aggressive therapy than individuals with smaller cancers. Now, researchers say that chemotherapy with fluorouracil and cisplatin, followed by a combination of radiation therapy and chemotherapy with fluorouracil and mitomycin, may help preserve bowel function and improve survival for persons with this type of disease. Cancer of the anus , the opening at the end of the rectum, is an uncommon cancer. Depending on the stage of disease (extent of disease at diagnosis) and other factors, cancer of the anus may be treated with surgery, chemotherapy, and/or radiation therapy. Persons who have surgery for anal cancer sometimes need a colostomy , an opening created from the skin to the bowel to help dispose of waste; however, a colostomy is usually temporary. Persons who have anal cancer that can be operated upon are often treated with surgery followed by a combination of radiation therapy and chemotherapy with fluorouracil and mitomycin. Seventy percent of these individuals are cured and maintain bowel functioning. However, persons with anal cancers that are large in size or have spread to the lymph nodes, do not respond as well to the standard therapies and need more aggressive treatment. Researchers from the Cancer and Acute Leukemia Group B conducted a study with the hope of improving survival rates and preserving bowel function for persons with cancer of the anal canal that were large in size or had spread to the lymph nodes. Forty-five patients first received chemotherapy with fluorouracil and cisplatin. They then received a combination of radiation therapy and chemotherapy with fluorouracil and mitomycin. Thirty-six patients had a complete response to the therapy. After an average of 21 months, 78% of the patients were alive and 67% were free from any signs and symptoms of cancer. Fifty-six percent of those who were alive were without a colostomy. The researchers concluded that this more aggressive combination of chemotherapy and radiation therapy appears to result in better survival and better preservation of bowel functioning than the standard regimens for persons with more advanced anal cancer. Persons with this type of disease may wish to talk with their doctor about the risks and benefits of receiving intensive chemotherapy with radiation therapy or of participating in a clinical trial in which other promising new therapies are being studied. Two sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute ( cancer.gov ) and the Clinical Trials section and service offered by Cancer Consultants.com ( www.411cancer.com ). ( Proceedings of the American Society of Clinical Oncology Thirty-Fifth Annual Meeting , Vol 18, Abstract 909, pp 237a, 1999)

Treatment of Anal Cancer: Protective Drug, Called Amifostine, Reduces the Side Effects of Chemotherapy and Radiation Therapy

Treatment of Anal Cancer: Protective Drug, Called Amifostine, Reduces the Side Effects of Chemotherapy and Radiation Therapy The side effects of chemotherapy and radiation therapy as treatment for anal cancer may be reduced with the use of a drug called amifostine, according to new research findings by German doctors. Cancer of the anus, the opening at the end of the rectum, is an uncommon cancer. Depending on the stage of disease (extent of disease at the time of diagnosis) and other factors, anal cancer may be treated with surgery, chemotherapy, and/or radiation therapy. Radiation and chemotherapy are often administered after surgery (called adjuvant treatment) to help control the cancer, but these treatments often cause side effects. Over the past 50 years, many drugs, called radiation protectors, have been tested in the laboratory for the prevention of damage to healthy cells and tissues from radiation therapy. For such drugs to work effectively, they must protect the healthy cells, but not the cancerous cells. Amifostine is the only agent of this category to be approved by the US Food and Drug Administration for use in patients receiving radiation therapy for cancer of the head and neck. This drug has also been shown to reduce the side effects from chemotherapy in patients with cancer of the ovary. Doctors in Germany studied the protective effects of amifostine in patients receiving both chemotherapy and radiation therapy for cancer of the anus. In this study, 30 patients with advanced cancer of the anus underwent surgery, then 5 weeks of radiation therapy and chemotherapy. Half of the patients also received amifostine in weeks 1 and 5 of treatment, while the other half received no amifostine. The results show that amifostine was associated with a reduction in side effects of the skin, bowel, and blood. The side effects associated with amifostine use included low blood pressure and nausea. The researchers concluded that amifostine may be a useful agent in preventing the side effects caused by radiation therapy and chemotherapy in patients with cancer of the anus. Further studies of the protective effects of amifostine against radiation therapy and/or chemotherapy for other types of cancer are needed. ( Presented at the 41st Annual Meeting of the American Society of Therapeutic Radiology and Oncology , October 31, 1999, San Antonio, Texas)