- The American Radium Society has issued Appropriate Use Criteria for curative-intent treatment of nonmetastatic anal squamous cell cancer.
- The evidence-based guidelines were developed by a multidisciplinary expert panel.
Why this matters
- Anal cancer incidence has increased in recent years and now represents 17% of lower gastrointestinal malignancies.
- Radiotherapy combined with 5-FU and mitomycin is the standard of care for curative-intent treatment of nonmetastatic anal cancer. Oral capecitabine can be substituted for 5-FU.
- Induction chemotherapy is NOT recommended, as it is usually not appropriate in this population.
- Radiotherapy doses to the primary tumor should be between 50 and 59.4 Gy.
- Intensity-modulated radiotherapy (IMRT) is recommended over 3D conformal radiotherapy.
- Simultaneous-integrated boost IMRT is recommended in combined modality treatment of patients with locally advanced anal cancer.
- Assessments for treatment response should start at 8 weeks after the end of therapy. Biopsies of stable or regressing disease should not be performed until at least 26 weeks after initiation of chemoradiotherapy.
- Abdominal-perineal resection (APR) should be used only for salvage.