Successful closure of anal cancer-related fistulas with upfront intra-arterial chemotherapy: a report of 8 cases.

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.