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Anal cancer: current and future treatment strategies

Authors Chin JY, Hong TS, Wo JY

Received 13 September 2012

Accepted for publication 5 November 2012

Published 17 January 2013 Volume 2013:3 Pages 19—27


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Joanna Y Chin, Theodore S Hong, Jennifer Y Wo

Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

Abstract: Anal cancer is a relatively rare malignancy, accounting for approximately 2% of gastrointestinal cancers. Concurrent chemoradiation with 5-fluorouracil/mitomycin remains the standard of care for the treatment of anal cancer. There is currently no proven role for platinum-based induction or adjuvant chemotherapy in anal cancer, even in cases of bulky disease. Multiple trials have shown that radiosensitization with concurrent chemotherapy is beneficial over radiation alone, and in particular, efforts to remove or substitute mitomycin from the chemoradiation regimen have been unsuccessful. Because local-regional control remains a challenge in the management of anal cancer, future studies will need to focus on radiation dose-escalation and/or addition of further chemotherapy or targeted agents. Patient selection, eg, with PET-CT or with biomarkers including HPV status, may be necessary to define patients who need more aggressive local treatment, ie, for patients with bulky disease, or to de-escalate treatment in others, ie, patients with early-stage, localized cancer.

Keywords: anal cancer, chemoradiation, IMRT

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