Anal carcinoma in mid-Norway 1970-2000

The treatment of anal carcinoma changed from surgery to chemoradiotherapy 20-25 years ago. The aim of this observational study was to compare surgery with chemoradiotherapy with regard to side effects, local recurrence and survival during and after the implementation of a new treatment policy for anal carcinoma. The study includes all 111 patients with anal carcinoma diagnosed between 1970 and 2000 in mid-Norway. One hundred patients were treated with the intention to cure, and 11 patients received palliative treatment. Thirty-four patients were treated with surgery alone, and 57 patients with chemoradiotherapy. Among patients treated for cure, 17 patients (17%) developed local recurrence; ten patients (33%) in the surgically treated group and 4 (7%) in the chemoradiotherapy group (p=0.15). Five year overall survival was 48% after surgery, compared to 78% after chemoradiotherapy (p=0.004). Stage, age and treatment were all significant indicators of survival in uni- and multivariable analysis. Late side effects were moderate after combined therapy; only one patient preferred getting a stoma due to radiation damage of the anal sphincter. The change of strategy for anal cancer treatment from surgery to combined therapy has probably reduced local recurrence and improved survival. Side effects in this series of patients were minor after chemoradiotherapy compared to a permanent stoma after surgery.