Advances in the Management of Anal Cancer

Abstract

Although anal squamous cell carcinoma (ASCC) is an uncommon malignancy, its incidence has been increasing markedly in recent decades due to its association with human papilloma virus (HPV) infection. The well-established standard of care for localized ASCC consists of the combination of 5-fluorouracil (5FU) and mitomycin (MMC) chemotherapy, concurrent with external beam radiation therapy (EBRT). However, newer techniques are being actively pursued, including the use of newer radiation therapy (RT) technologies, such as intensity-modulated radiation therapy (IMRT). The areas of debate and development include the dosing and timing of MMC delivery, the role of cisplatin chemotherapy as an alternative to MMC, the replacement of the standard 96-h infusion of 5FU with oral capecitabine, the use of targeted chemotherapy agents, and the duration and dose of RT.

PET-CT guided SIB-IMRT combined with concurrent 5-FU/MMC for the treatment of anal cancer

“…Though there is some conflicting data, overall treatment delays seem to have a detrimental effect upon disease outcomes in SCCAC, as treatment breaks allow for tumor cell repopulation [23]. When standard practice was still to deliver RT in two stages, patients with longer treatment gaps or overall treatment time (OTT) had worse LC.…”

Prognostic Impact of Residual HPV ctDNA Detection after Chemoradiotherapy for Anal Squamous Cell Carcinoma

“…Definitive chemoradiotherapy (CRT) is the current standard of care for patients diagnosed with locally advanced ASCC. Abdominoperineal resection is a salvage approach, which is reserved for patients with local relapse or persistent disease after CRT (4). However, no sensitive blood biomarkers are currently available to predict relapse in patients, as squamous cell carcinoma (SCC) antigen demonstrated low clinical validity in this setting (5), although the interpretation of conventional imaging can be challenging after CRT (4).…”

Rectal bleeding and prolapse� not always benign diseases rather anal cancer. The importance of a correct decision making since primary care

“…Established the diagnosis, the well-established standard of care for localized ASCC consists in the combination of 5-fluorouracil and mitomycin chemotherapy, concurrent with external beam radiation therapy (4).…”