Squamous cell carcinoma of the anal margin treated with radiotherapy

Squamous cell carcinoma of the anal margin is relatively rare. We present a series of patients treated with radiotherapy alone or combined with concomitant chemotherapy at our institution and review the pertinent literature. Ten patients with AJCC T2NO and T3NO squamous cell carcinoma of the anal margin were treated with radiotherapy alone or radiotherapy plus chemotherapy at the University of Florida between 1979 and 1993. All patients had a follow-up for at least 2 years, and no patient was lost to follow-up. All ten patients have remained continuously disease free after treatment. Three patients died of intercurrent disease at 29, 37 and 113 months after treatment. The remaining seven patients were alive and disease-free from 24 to 143 months after radiotherapy. No patient experienced a major complication and all retained a functional anal sphincter. Based on our experience and a review of the literature, superficial, well to moderately differentiated, T1 and T2 cancers may be successfully treated with radiotherapy alone or a local excision. More advanced lesions are best treated with combined radiotherapy and concomitant chemotherapy. Abdominoperineal resection should be reserved for those presenting with faecal incontinence and those with locally recurrent disease after previous radiotherapy.