FLUOROURACIL AND COMBINED EXTERNAL RADIOTHERAPY BRACHYTHERAPY IN ANAL CANAL CARCINOMA: RESULTS OF 7 CASES

Between May 1993 and June 1994, 7 patient (4 male and 3 female) with anal canal carcinoma were treated with curative intent in our department. Two of the patients had T4, 4 had T3 and 1 had T2 tumour and 1 case had perianal lymph node involvement (N1). Four patients, referred after biopsy, two patients after inadequate local excision and one patient after an attempt to Miles operation at which the patients were accepted as inoperable. External radiotherapy (ERT) was given through AP-PA portals including pelvic lymph nodes with 1.8 Gy/day fractions up to a total dose of 54 Gy. During the first and the last 4 days of treatment 5-fluorouracil 750 mg/m2/day was administered as an 8 hour infusion in a day. Brachytherapy was applied 5-6 weeks after ERT. Ten to 15 needles were inserted as a volume implant with the use of "Martinez Universal Perineal Interstitial Template-MUPIT" applicator. Five cases given 2x8.5 Gy with an 8 hour interval and two cases were given a single fraction of 10 Gy to the 85% reference isodose volume. The treatment was tolerated well by 5 patients. Grade III proctitis was seen in one patient, which subsided after medical treatment. One patient had both local recurrence and grade IV proctitis. Four cases were disease free at 31,. 39, 41, 42 months. One case without local disease was lost after 20 months because of liver metastasis and ascites. One case had local progression after 20 months however she was lost at the 10th month because of cardiac failure. The other case developed disseminated lung metastasis at the 4th month and local recurrence at the 12th month and died at 18th month.