Anal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up☆

Abstract

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A Pattern of Care Report on the Management of Patients with Squamous Cell Carcinoma of the Anus—A Study by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Tumors Study Group

“…This is in line with the results of a recent survey carried out in German-speaking countries [16,17]. In the recent ESMO guidelines, FDG-PET is considered as an exam to be recommended, but not mandated [8]. It has to be noted that, apart from staging purposes, FDG-PET may be clinically useful to confirm or not suspicious features detected on MRI, to drive target volume selection and delineation and to define organs at risk for tailored IMRT approaches [18][19][20].…”

“…The attitude toward the diagnostic biopsy of suspicious inguinal lymph nodes is rather cautious, with one out of three respondents never performing it and half of them requesting it in case of difficulties in the interpretation of the findings coming from morphologic and/or functional imaging. The latter approach is in line with the ESMO guidelines, suggesting a further characterization of enlarged inguinal nodes when confirmatory features of malignancy are lacking on either pelvic MRI or FDG/PET [8]. Routine HIV screening is performed by half of the centers participating in the survey, while around 40% would do it occasionally or in individuals at risk.…”

“…With respect to pre-treatment and staging imaging modalities, thorax and abdominal CT, together with pelvic MRI, are prescribed by the vast majority of respondents (>85%), while FDG-PET is used by two out of three participants. Pelvic MRI is considered a mandatory examination to be requested, in agreement with the updated European Society for Medical Oncology (ESMO) guidelines [8]. Conversely, FDG-PET is considered an optional or second-level examination by more than 60% of respondents.…”

“…It has to be noted that, apart from staging purposes, FDG-PET may be clinically useful to confirm or not suspicious features detected on MRI, to drive target volume selection and delineation and to define organs at risk for tailored IMRT approaches [18][19][20]. Interestingly, gynecological examination is performed by around one out of five participants, even if it is mandated in the ESMO guidelines during the diagnostic work-up [8]. The attitude toward the diagnostic biopsy of suspicious inguinal lymph nodes is rather cautious, with one out of three respondents never performing it and half of them requesting it in case of difficulties in the interpretation of the findings coming from morphologic and/or functional imaging.…”

“…Radiotherapy (RT) delivery is based on intensity modulated radiotherapy (IMRT), usually supported by image guidance (IGRT) [6,7]. Several national and international guidelines provide indications for diagnosis, staging, treatment and follow-up [8][9][10][11][12]. In 2014, the Italian Association for Radiotherapy and Clinical Oncology (AIRO), developed national guidelines dedicated to the RT treatment of tumors of the gastrointestinal tract, including SCC of the anus, to optimize and homogenize treatment approaches within the Italian radiation oncology community [13].…”