Dr Pascal Gervaz

Chirurgien FMH, chirurgie interne & chirurgie viscérale

 

 

Successful Closure of Anal Cancer-Related Fistulas with Upfront Intra-Arterial Chemotherapy: a Report of 8 Cases.

 

 

 

 

 

 

by Robert Kridel, M.D., Stéphane Cochet M.D., Bruno Roche M.D., Albéric Bressoud M.D., Pascal Gervaz M.D., Michael Betz, M.D., Arnaud D. Roth, M.D

 

 

Background

Fistulas arising from the perforation of anal cancer into adjacent organs are a debilitating complication in the course of the disease.

 

Objective

We studied intra-arterial chemotherapy as a strategy to close such fistulas before the initiation of standard chemoradiation.

 

Design

This study was based on a retrospective chart review.

 

Setting

The investigation was conducted at Geneva University Hospital.

 

Patients

Eight patients with anal cancer-related fistulas were included in the study.

 

Intervention

Patients were treated at our institution from 2002 to 2009 with upfront chemotherapy consisting of 1 to 4 cycles of intra-arterial cisplatin, 5-fluorouracil, methotrexate, and mitomycin C, and intravenous bleomycin. Intra-arterial chemotherapy was followed by standard chemoradiation.

 

Main Outcome Measure

Fistula closure was assessed by an expert proctologist.

 

Results

Complete closure of fistulas was documented in 7 of 8 patients. Toxicity was manageable and consisted mainly of thrombocytopenia, neutropenia, and febrile neutropenia as well as fatigue.

 

Limitations

This is a retrospective, uncontrolled review of only 8 patients and thus a meaningful comparison with standard chemoradiation is not feasible.

 

Conclusion

Upfront intra-arterial chemotherapy is a promising strategy to close anal cancer-related fistulas before initiating chemoradiation, potentially obviating the need for hazardous reconstructive surgery after radiotherapy.

 

 

in Diseases of the colon and rectum 2011 May; 54(5): 566-9. doi: 10. 1007/DCR. 0b013e31820d8333