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Surgical Resection Beneficial Treatment for Anal Cancer Unresponsive to Radiation and Chemotherapy: Presented at SSO

By Mary Beth Nierengarten

CHICAGO -- March 19, 2008 -- Surgical resection confers survival outcomes comparable with radiation alone for patients with anal cancer who fail initial treatment with radiation plus chemotherapy, reports a study presented here at the Society of Surgical Oncology (SSO) 61st Annual Cancer Symposium.

Although surgery is commonly used to treat patients who fail initial treatment of anal cancer, there has been minimal data on the outcomes of these patients. Investigators from the Cleveland Clinic Foundation in Cleveland, Ohio evaluated outcomes of patients who underwent surgery after radiation (SRT) as salvage therapy, and compared these with outcomes of patients treated with radiation alone (RT)

Prospective, population-based data from the Surveillance Epidemiology and End Results database were used to identify patients who were treated by SRT and RT from 1983 to 2002. Inclusion criteria for the SRT group included patients who received abdominoperineal resection, resection of the primary site with or without lymph node dissection, and radical resection of adjoining organs.

Patients were excluded who had distant disease, lymphoma, sarcoma, overlapping lesions of the rectum and anal canal, or underwent only local therapy and excisional biopsy.

Overall, 1,192 patients were included in the study -- 957 patients treated by SRT and 235 by RT. Age, gender, tumour site, and type of radiation were similar between the 2 groups. Compared with patients in the RT group, patients in the SRT group had significantly more poorly differentiated tumours and anaplastic tumours (P < .0001) with regional disease (41.2% vs 65%, P < .001).

The study found no difference in the median survival of the 2 treatment groups, with median survival time of 93 months for the SRT patients compared with 97 months for the RT patients (P = .7).

"Surgery does help patients [who fail initial therapy], and, in fact, survival for patients undergoing surgery -- called salvage surgery -- is equivalent to those treated with radiation alone, despite the surgical-group patients having more advanced disease (regional stage)," said lead author, Ravi P. Kiran, MD, Associate Staff, Associate Director of Clinical Research, Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.

Based on these outcomes, Dr. Kiran said in a presentation on March 14, "such patients should be offered surgery, as they would be expected to have good outcomes."


[Presentation title: Is Survival Reduced for Patients With Anal Cancer Requiring Surgery After Failure of Radiation? P79]

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