Viszeralchirurgie 2001; 36(3): 119-125
DOI: 10.1055/s-2001-15012
AKTUELLE CHIRURGIE
© Georg Thieme Verlag Stuttgart · New York

Moderne Behandlungskonzepte
beim Analkarzinom

Update treatment concepts in anal carcinomaM.  H.  Seegenschmiedt1 , M.  Betzler2
  • 1Klinik für Radioonkologie, Strahlentherapie und Nuklearmedizin
  • 2Klinik für Allgemeine Chirurgie, Viszeral- und Gefäßchirurgie
  • Alfred Krupp Krankenhaus, Essen
Further Information

Publication History

Publication Date:
31 December 2001 (online)

Einführung

Diagnostik und Therapie des Analkarzinoms haben sich in den letzten zwei Jahrzehnten stark gewandelt. Bei der Diagnostik spielen endoluminale Sonographie und Probebiopsie zur genauen Tumorklassifikation eine wichtige Rolle. In der Therapie haben sich funktionelle, den Sphinkter erhaltende Konzepte durchgesetzt, insbesondere die Radiochemotherapie, die sich durch gutes Ansprechen und geringe Nebenwirkungen auszeichnet. Radikale chirurgische Maßnahmen sind heute nur noch unter palliativen Gesichtspunkten und bei Nichtansprechen bzw. Lokalrezidiv nach Primärtherapie erforderlich [6] [7] [13] [19] [26] [30] [31] [36] [39] [43] [46] [51] [55] [57] [59] [61].

Literatur

  • 1 Al Surf A S, Turnbull R B, Fazio V W. Local treatment of squamous cell carcinoma of the anus.  Surg Gynecol Obstet. 1979;  148 576-578
  • 2 Allal A S, Kurtz J M, Pipard G. et al . Chemoradiotherapy versus radiotherapy alone for anal cancer: a retrospective comparison.  Int J Radiat Oncol Biol Phys. 1993;  27 59-66
  • 3 Allal A S, Laurencet F M, Reymond M A, Kurtz J M, Marti M C. Effectiveness of surgical salvage therapy for patients with locally uncontrolled anal carcinoma after sphincter-conserving treatment.  Cancer. 1999;  86 405-409
  • 4 Anthony T, Simmang C, Lee E L, Turnage R H. Perianal mucinous adenocarcinoma.  J Surg Oncol. 1997;  64 218-221
  • 5 Bartelink H, Roelofsen F, Eschwege F. et al . Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: Results of a phase III randomized trial of the European Organisation for research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups.  J Clin Oncol. 1997;  15 2040-2049
  • 6 Basik M, Rodriges Bigas M A, Penetrante R, Petrelli N J. Prognosis and recurrence patterns of anal adenocarcinoma.  Am J Surg. 1995;  169 233-237
  • 7 Beahrs O H. Management of cancer of the anus.  Am J Roentgenol. 1979;  133 791-795
  • 8 Beckman A M, Daling J R, Sherman K J. et al . Human papilloma virus infection and anal cancer.  Int J Cancer. 1989;  43 1042-1049
  • 9 Boman B M, Moertel C G, O'Connel M J. et al . Carcinoma of the anal canal - a clinical and pathologic study of 188 cases.  Cancer. 1984;  54 114-125
  • 10 Cantril S T, Green J P, Schall G L, Schaupp W C. Primary radiation therapy in the treatment of anal carcinoma.  Int J Radiat Oncol Biol Phys. 1983;  9 1271-1278
  • 11 Constantinou E C, Daly W, Fung C Y, Willett C G, Kaufman D S, DeLaney T F. Time-Dose considerations in the treatment of anal cancer.  Int J Radiat Oncol Biol Phys. 1997;  39 651-657
  • 12 Cummings B J, Keane T J, O'Sullivan B, Wong C S, Catton C N. Epidermoid anal cancer: Treatment by radiation alone or by radiation and 5-Fluorouracil with and without mitomycin C.  Int J Radiat Oncol Biol Phys. 1991;  21 1115-1125
  • 13 Cummings B J. Anal cancer.  Int J Radiat Oncol Biol Phys. 1990;  19 1309-1315
  • 14 Cutuli B, Fenton J, Labib A, Bataini J P, Mathieu G. Anal margin carcinoma: 21 cases treated at the Institut Curie by exclusive conservative radiotherapy.  Radiother Oncol. 1988;  11 1-6
  • 15 Daling J R, Weiss N S, Hislop T G. et al . Sexual practices, sexually transmitted diseases, and the incidence of anal cancer.  N Engl J Med. 1987;  317 973-977
  • 16 Doci R, Zucali R, La Monica G. et al . Primary chemoradiation therapy with fluorouracil and cisplatin for cancer of the anus: results in 35 consecutive patients.  J Clin Oncol. 1996;  14 121-125
  • 17 Doggett S W, Green J P, Cantril S T. Efficacy of radiation therapy alone for limited squamous cell carcinoma of the anal canal.  Int J Radiat Oncol Biol Phys. 1988;  15 1069-1072
  • 18 Dubois J B, Garrigues J M, Pujol H. Cancer of the anal canal: report on the experience of 61 patients.  Int J Radiat Oncol Biol Phys. 1991;  20 575-580
  • 19 Dunst J, Reichard U, Wolf N, Sauer R. Funktionserhaltende Therapie des Analkarzinoms durch simultane Radiochemotherapie.  Dtsch Med Wschr. 1987;  112 1201-1205
  • 20 Eschwege F, Laser P, Chavy A. et al . Squamous cell carcinoma of the anal canal: treatment by external beam irradiation.  Radiother Oncol. 1985;  3 145-150
  • 21 Flam M S, John M, Pajak T, Petrelli N. et al . Role of mitomycin C in combination with fluorouracil and radiotherapy and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: Results of a phase III randomized intergroup study.  J Clin Oncol. 1996;  14 2527-2539
  • 22 Frisch M, Glimelius B, van den Brule A JC. et al . Sexually transmitted infections as a cause of anal cancer.  N Engl J Med. 1997;  337 1350-1358
  • 23 Frisch M, Olsen J H, Bautz A, Melbye M. Benign anal lesions and the risk of anal cancer.  N Engl J Med. 1994;  331 300-302
  • 24 Frost D B, Richards P C, Montague E D, Giacco G G, Martin R G. Epidermoid cancer of the anorectum.  Cancer. 1984;  53 1285-1293
  • 25 Gerard J P, Ayzac L, Hun D. et al . Treatment of anal canal carcinoma with high dose radiation therapy and concomitant fluorouracil-cisplatinum. Long-term results in 95 patients.  Radiother Oncol. 1998;  46 249-256
  • 26 Grabenbauer G G, Matzel K L, Schneider I HF. et al . Sphincter preservation with chemoradiation in anal canal carcinoma - Abdominoperineal resection in selected cases?.  Dis Col Rectum. 1998;  41 441-450
  • 27 Grabenbauer G G, Panzer M, Hültenschmidt B. et al . Combined radiation and chemotherapy for squamous cell carcinoma of the anal canal: Results and prognostic variables in a multi-institutional series of 173 patients.  Radiol Oncol. 1997;  31 219-227
  • 28 Grabenbauer G G, Panzer M, Hültenschmidt B. et al . Prognostische Faktoren nach simultaner Radiochemotherapie des Analkanalkarzinoms in einer multizentrischen Serie von 139 Patienten.  Strahlenther Onkol. 1994;  170 391-399
  • 29 Grabenbauer G G, Schneider I HF, Gall F P, Sauer R. Epidermoid carcinoma of the anal canal: treatment by combined radiation and chemotherapy.  Radiother Oncol. 1993;  27 59-62
  • 30 Grabenbauer G G, Wolf N, Dunst J, Sauer R. Analkanalkarzinom: Diagnostik-Therapie-Prognose.  Strahlenther Onkol. 1989;  165 829-836
  • 31 Hager T, Hermanek P. Maligne Tumoren der analregion. In: Gall FP, Hermanek P, Tonak J (eds) Chirurgische Onkologie.  Berlin; Springer 1987
  • 32 Higgins G D, Uzelin D M, Phillips G E. et al . Differing characteristics of human papillomavirus RNA-positive and RNA-negative anal carcinomas.  Cancer. 1991;  68 561-567
  • 33 Hill S A, Coghill S B. Human papillomavirus in squamous carcinoma of anus.  Lancet. 1986;  6 1333
  • 34 Hoffman R, Welton M L, Klencke B, Weinberg V, Krieg R. The significance of pretretment CD4 count on the outcome and treatment tolerance of HIV-positive patients with anal cancer.  Int J Radiat Oncol Biol Phys. 1999;  44 127-131
  • 35 Holly E A, Whittemore A S, Aston D A. et al . Anal cancer incidence: genital warts, anal fissure or fistula, hemorrhoids, and smoking.  J Natl Caner Inst. 1989;  81 1726-1731
  • 36 Hughes L L, Rich T A, Delclos L, Ajani J A, Martin R G. Radiotherapy for anal cancer: experience from 1979 - 1987.  Int J Radiat Oncol Biol Phys. 1989;  17 1153-1160
  • 37 John M, Flam M, Pajak T. et al . Is mitomycin C necessary in the chemoradiation regimen for anal canal carcinoma? Interim results of a phase III randomized intergroup study.  Int J Radiat Oncol Biol Phys. 1993;  27 191
  • 38 John M, Pajak T, Flam M, et al. Dose escalation in chemoradiation for anal cancer: preliminary results of RTOG 92-08.  Cancer J Sci Am. 1996;  2 205-211
  • 39 Leichman L, Nigro N, Vaikevicius V K. et al . Cance rof the anal cancer: model for preoperative adjuvant combined modality therapy.  Am J Med. 1985;  78 211-215
  • 40 Mahjoubi M, Sadek H, Francois E. Epidermoid anal cancer. Activity of cisplatin and continuous 5-FU in metastatic and/or locally recurrent diesease.  Proc Am Soc Clin Oncol. 1990;  9 114
  • 41 Martenson J A, Gunderson L L. External radiation therapy without chemotherapy in the management of anal cancer.  Cancer. 1993;  71 1736-1740
  • 42 Ng Y K, Pigneux J, Auvray H. et al . Our experience of conservative treatment of anal canal carcinoma combining external irradiation and interstitial implant: 32 cases treated between 1973 and 1982.  Int J Radiat Oncol Biol Phys. 1988;  14 253-259
  • 43 Nigro N D, Vaitkevicius V K, Considine B. Combined therapy for cancer of the anal canal.  Dis Colon Rectum. 1974;  27 763-766
  • 44 Palevsky J M, Holly E A, Hogeboom C J. et al . Anal cytology as a screening tool for anal squamous intraepithelial lesions.  J Aquir Immune Defic Syndr Hum Retroviral. 1997;  14 405-412
  • 45 Panzer M, Sutter T, Wendt T, Jauch K W. Radiochemotherapie mit und ohne Radikaloperation bei Analkarzinom: Großhaderner Langzeitergebnisse.  Tumordiagn u Ther. 1993;  14 167-174
  • 46 Papillon J, Chassard J L. Respective roles of radiotherapy and surgery in the management of epidermoid carcinoma of the anal margin.  Dis Colon Rectum. 1992;  35 422-429
  • 47 Papillon J, Montbaron J F, Gerard J P. et al .Role of combined radiation and chemotherapy; the Lyon experience. In: Sauer R (ed) Interventional radiation therapy.  Springer; Berlin 1991
  • 48 Papillon J, Montbaron J F. Epidermoid carcinoma of the anal canal. A series of 276 cases.  Dis Colon Rectum. 1987;  5 324-333
  • 49 Peddada A V, Smith D E, Rao A R, Frost D B, Kagan A R. Chemotherapy and low-dose radiotherapy in the treatment of HIV-infected patients with carcinoma of the anal canal.  Int J Radiat Oncol Biol Phys. 1997;  37 1101-1105
  • 50 Peiffert D, Seitz J F, Rougier P. et al . Preliminary results of a phase II study of high-dose radiation therapy and neoadjuvant plus concomitant 5-fluorouracil with CDDP chemotherapy for patients with anal canal cancer: a French cooperative study.  Ann Oncol. 1997;  8 575-581
  • 51 Pintor M P, Northover J M, Nicolls R J. Squamous cell carcinoma of the anus 1948 - 1984.  Br J Surg. 1989;  76 806-810
  • 52 Pipard G. Combined therapy of anal canal cancer: a report on external irradiation with or without chemotherapy followed by interstitial Ir-192. In: Sauer R (ed) Interventional radiation therapy.  Springer; Berlin 1991
  • 53 Pocard M, Tiret E, Nugent K, Dehni N, Pare R. Results of salvage abdominoperineal resection for anal cancer after radiotherapy.  Dis Colon Rectum. 1998;  41 1488-1493
  • 54 Roelofsen F, Bosset J, Eschwege F. et al . Concomitant radiotherapy and chemotherapy superior to radiotherapy alone in the treatment of locally advanced anal cancer. Results of a phase III randomized trial.  ASCO Abstr. 1995;  14 194
  • 55 Sawyers J L. Squamous cell cancer of the perianus and anus.  Surg Clin N Amer. 1972;  52 935-942
  • 56 Schlienger M, Krzisch C, Pene F. et al . Epidermoid carcinoma of the anal canal: treatment results and prognostic variables in a series of 242 cases.  Int J Radiat Oncol Biol Phys. 1989;  17 1141-1151
  • 57 Schneider I HF, Grabenbauer G G, Köckerling F, Sauer R, Gall F P. Die Therapie des Analkarzinoms. In: Bünte H, Junginger Th (eds) Jahrbuch der Chirurgie 1993.  Zülpich; Biermann 1993
  • 58 Schneider I HF, Grabenbauer G G, Reck T, Köckerling F, Sauer R, Gall F P. Combined radiation and chemotherapy for epidermoid carcinoma of the anal canal.  Int J Colorect Dis. 1992;  7 192-196
  • 59 Sischy B. The use of radiation therapy combined with chemotherapy in the management of squamous cell carcinoma of the anus.  Int J Radiat Oncol Biol Phys. 1985;  11 1587-1593
  • 60 Touboul E, Schlienger M, Buffat L. et al . Epidermoid carcinoma of the anal margin: 17 cases treated with curative intent radiation therapy.  Radiother Oncol. 1995;  34 195-202
  • 61 Touboul E, Schlienger M, Buffat L. et al . Epidermoid carcinoma of the anal canal.  Cancer. 1994;  73 1569-1579
  • 62 UICC .TNM-Klassifikation maligner Tumoren. 5. Aufl. Berlin, Heidelberg, New York; Springer 1997
  • 63 UKCCCR Anal Canal Cancer Working Party . Epidermoid anal cancer: results from the UKCCCR randomized trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin.  Lancet. 1996;  348 1049-1054
  • 64 Wagner J P, Mahe M A, Romestaing P. et al . Radiation therapy in the conservative treatment of carcinoma of the anal canal.  Int J Radiat Oncol Biol Phys. 1994;  29 17-23
  • 65 WHO .Histological typing of intestinal tumors. In: Jass JR, Sobin LH (eds) International Histological Classification of tumors. 2. Aufl.  Heidelberg, New York, Tokyo; Springer 1989: XX

Prof. Dr. med. M. Heinrich Seegenschmiedt

Klinik für Radioonkologie,
Strahlentherapie und Nuklearmedizin
Alfried Krupp-Krankenhaus

Alfried-Krupp-Straße 21
45117 Essen

Phone: + 49-201-4342560

Fax: + 49-201-4342371

Email: seegenschmiedt.heinrich@krupp-krankenhaus.de