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Purpose: This retrospective analysis is aimed to report the single institution experience from an Asian country utilizing Intensity Modulated Radiotherapy (IMRT) based Chemo radiation in Anal Canal Squamous Cell Carcinoma (ASCC) with an emphasis on efcacy, toxicity and disease and treatment-related variables associated with outcomes. Study was conduc Materials And Methods: ted in the department of Radiation Oncology at Regional Cancer Center, Thiruvananthapuram. All Patients with biopsy proven ASCC diagnosed between January 2014 and December 2018 and receiving curative intent IMRT were identied and follow up data till December 2020 was collected. Primary end point was Disease-free survival (DFS). Secondary end points were Overall Survival (OS), Colostomy-free survival (CFS) Loco regional Failure (LRF) and Toxicities. A total of 34 patients were analyzed during a median follow up of Results: 34 months. Twenty ve patients (73.5%) were in stage IIIB. Median overall treatment time was 36 days. The estimated two year DFS, OS and CFS were 79.4 %, 93.9 %and 97% respectively. Disease recurrence at any point on follow up occurred in ve patients (14.7%). Primary Tumor size of more than or equal to 5 cm and development of grade three anemia during RT was associated with inferior DFS in Univariate analysis. Patients taken less than two cycles of chemotherapy, there was a trend for inferior OS. Acute grade 3 or more dermatological toxicities was 44% and hematological toxicity was 35.3%. Radiotherapy break occurred in 38.2%of patients with a median of 5.5 days (range 2-13). Of the available patients chronic toxicities were reported for 40% and were of grade 2. IMRT is associated with favorable toxicity rates and excellent Conclusion: long-term efcacy in Asian population also where patients are presenting in an advanced stage. Reducing the total treatment time by SIB technique may improve the clinical outcome.

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