—Myerson RJ, Karnell LH, Menck HR. The national cancer data base report on carcinoma of the anus. Cancer 1997; 80:805-15. (!)

The last 15 years have seen substantial advances in the management of anal carcinoma, primarily in the use of radiochemotherapy as definitive or adjuvant treatment. In this study, data on 2,339 NCDB patients with anal carcinoma diagnosed in 1988 and 1993 were reviewed for presentation, patterns of care, and outcome. There was an increase in the use of chemotherapy between 1988 and 1993 (61.6% to 67.2%), and substantial differences in management between epidermoid carcinomas and adenocarcinomas. The majority of epidermoid carcinomas were managed nonsurgically, principally with combined chemotherapy and radiation. Three-fourths of adenocarcinomas received surgery. The most important factors for favorable 5-year, disease-specific survival were early stage (ranging from 71.3% for stage I to 23.1% for stage IV), epidermoid carcinoma histology (57.6% vs. 41.3% for adenocarcinoma), and female gender (56.2% vs. 49.6% for males). For stage I-II epidermoid carcinomas, the 5-year survival for patients receiving nonsurgical treatment with radiochemotherapy was equivalent to that of patients receiving surgical treatment (64.0% and 65.4%, respectively). These results confirm a trend in patterns of care favoring nonsurgical management with radiochemotherapy for epidermoid carcinomas of the anus. For adenocarcinomas, the trend has been toward increasing the use of multimodality therapy with surgery and adjuvant radiochemotherapy. Survival data from the 1988 cases confirm the efficacy of conservative treatment with radiation plus chemotherapy for epidermoid carcinomas.

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