American Radium Society issues evidence-based guidelines for anal cancer

  • Russo S & al.
  • Int J Radiat Oncol Biol Phys
  • 6 Jul 2019

  • Oncology guidelines update
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Takeaway

  • 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.

Key points

  • 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.