Materiały źródłowe

• #1 Anal Cancer | Harold C. Simmons Comprehensive Cancer Center | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/anal-cancer/

  Cancer specialists at UT Southwestern Medical Center have experience treating all types of cancer, even rare types such as anal cancer. Our gastrointestinal cancer experts provide compassionate care using the latest advancements in diagnosis and treatment for the best possible outcomes. […] At Simmons Cancer Center, our specialists take a team approach to anal cancer care. We combine expertise from gastroenterologists and medical, surgical, and radiation oncologists to provide comprehensive care from initial evaluation and diagnosis through treatment and follow-up care. […] Treatment options vary depending on factors such as the location of the cancer, whether it has spread outside the anus, and whether the patient has other health conditions that weaken immunity. […] We usually begin treatment for anal cancer with a combination of chemotherapy and radiation therapy, known as chemoradiation:

• #2 Treatment for Anal Cancer | Fred Hutchinson Cancer Center

  https://www.fredhutch.org/en/diseases/anal-cancer/treatment.html

  Fred Hutchinson Cancer Center experts offer comprehensive care for anal cancer, including advanced treatments and new options available only through clinical studies. […] Most patients with anal or colorectal cancer are seen at our Colorectal Cancer Specialty Clinic. […] We view treatment as a collaborative effort. Your Fred Hutch physicians will explain all your options and recommend a treatment plan to get you the best results based on the type, stage and location of your cancer and your health, lifestyle and preferences. […] Fred Hutch patients have access to advanced therapies being explored in clinical studies for anal cancer conducted here and at UW Medicine. […] Most people with anal cancer have a combination of radiation therapy and chemotherapy, called chemoradiation. This combination may cure anal cancer without the need for surgery.

• #3 Anal cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-cancer/diagnosis-treatment/drc-20354146

  Anal cancer treatment often starts with chemotherapy and radiation therapy. Sometimes surgery is used to remove the cancer. When the cancer spreads to other parts of the body, different treatments might be used. These might include chemotherapy on its own and immunotherapy. The treatment that’s best for you depends on several factors. These include the stage of your cancer, your overall health and your own preferences. […] Anal cancer is usually treated with a combination of chemotherapy and radiation. Together, these two treatments enhance each other to kill cancer cells. […] Radiation is typically given daily over several weeks. How often you receive chemotherapy treatments over those weeks will depend on what medicines your healthcare team chooses. Your care team tailors your treatment schedule based on characteristics of your cancer and your overall health.

• #4 Anal Cancer Treatment – NCI

  https://www.cancer.gov/types/anal/patient/anal-treatment-pdq

  Anal cancer is a type of cancer that forms in the tissues of the anus. […] There are different types of treatment for people with anal cancer. […] The following types of treatment are used: Surgery, Radiation therapy, Chemotherapy. […] Treatment of stage 0 is usually local resection. […] Treatment of stage I, stage II, and stage III anal cancer may include: local resection for tumors of the skin around the outside of the anus and tumors inside the anal opening that do not involve the anal sphincter, external beam radiation therapy with chemotherapy, radiation therapy alone, abdominoperineal resection, if cancer remains or comes back after treatment with radiation therapy and chemotherapy, or other options that may include treatment with additional chemoradiation therapy, chemotherapy alone, or immunotherapy.

• #5 Rectal Cancer Treatment – NCI

  https://www.cancer.gov/types/colorectal/patient/rectal-treatment-pdq

  There are different types of treatment for people with rectal cancer. […] The following types of treatment are used: Surgery, Radiation therapy, Chemotherapy, Chemoradiation therapy, Active surveillance, Targeted therapy, Immunotherapy. […] Surgery is the most common treatment for all stages of rectal cancer. […] Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. […] Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. […] Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both. […] Treatment of stage 0 may include the following types of surgery: simple polypectomy, local excision, resection (when the tumor is too large to remove by local excision).

• #6 Recent Advances in the Management of Anal Cancer

  https://www.mdpi.com/2227-9032/11/23/3010

  The incidence and mortality of squamous cell carcinoma of the anus (SCCA) is on the rise, which highlights the unmet need for advances in treatment options. […] The landscape of treatment for this cancer is rapidly evolving with novel combination strategies including immunotherapy, radiation therapy and biomarker-guided therapy. […] The recent focus on locoregional SCCA management is to tailor treatment according to tumor burden and minimize treatment-related toxicities. […] Mitomycin plus either infusional 5-fluorouracil (5-FU) or capecitabine is used for first-line chemoradiotherapy (CRT), and intensity-modulated radiotherapy (IMRT) is the preferred modality for radiation for locoregional anal cancer. […] Systemic treatment is first-line for metastatic SCCA and immunotherapy with nivolumab and pembrolizumab being included as second-line agents.

• #7 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  For the majority of patients diagnosed with anal squamous cell carcinoma, treatment will consist of radiation therapy combined with radiosensitizing chemotherapeutic agents. This treatment method has remained remarkably unchanged since its advent as the so-called Nigro Protocol in 1974. More recently, immune checkpoint inhibitors (eg, pembrolizumab, nivolumab) have entered clinical practice as second-line agents. […] Surgery plays a limited role in the treatment for anal cancer. National Comprehensive Cancer Network (NCCN) guidelines consider local excision appropriate only for selected patients with superficially invasive squamous cell carcinoma (SCC) of the anus or early perianal (anal margin) SCC. Radical surgery is indicated for residual or recurrent cancer in the anal canal after nonoperative therapy.

• #8 Treatment for anal cancer – NHS

  https://www.nhs.uk/conditions/anal-cancer/treatment/

  Anal cancer is often treatable when found early. […] The main treatment for anal cancer is a combination of radiotherapy and chemotherapy, called chemoradiation (or chemoradiotherapy). […] Other treatments include chemotherapy or radiotherapy on their own, and surgery. […] To treat anal cancer, chemotherapy and radiotherapy are often used together. This is called chemoradiation or chemoradiotherapy. […] Chemoradiation is usually given if anal cancer has not spread. It means most people with anal cancer do not need to have surgery. […] Surgery is sometimes used to treat anal cancer. […] You may have surgery if the cancer is small and has not spread. […] Surgery for anal cancer usually involves removing just the part of the anus that’s affected. […] If the cancer has spread or come back, you may need surgery to remove all of the anus, the rectum (which joins the anus to the bowel) and part of the bowel. […] This means you’ll need to have a pouch (stoma bag) fitted to the outside of your body to collect poo. This is called a colostomy.

• #9 Anal Cancer Treatment Options | The Anal Cancer Foundation

  https://www.analcancerfoundation.org/treatment/

  If you or a loved one have been diagnosed with anal cancer, there are a range of options for treatment as well as new advancements emerging. The different treatment options also depend on the stage of anal cancer the patient is at, which we have broken down below. […] Anal cancer treatment can include surgery, chemotherapy, and radiation as well as emerging therapies. There are treatments for squamous and non-squamous forms of anal cancer. […] Treatment options for anal cancer depend on stage and type. The US National Comprehensive Cancer Network (NCCN) produces an in-depth anal cancer treatment guidelines document that is updated yearly. The document has a detailed and technical overview of treatment pathways and regimens. […] For stages I – III, the standard protocol is radiation and chemotherapy, used in conjunction with one another (often called 'chemoradiation’). The combination of chemotherapy and radiation has been found to be more effective than surgery in treating these stages of anal cancer.

• #10 Anal Cancer Treatment Options | The Anal Cancer Foundation

  https://www.analcancerfoundation.org/treatment/

  The chemotherapy and radiation protocols that have been used for decades are known collectively as the Nigro Protocol. The Nigro Protocol typically includes several weeks of radiation with two different types of chemotherapy given at the beginning and end of treatment. […] Treatment for anal cancer has remained overwhelmingly the same since the 1970s. The Nigro Protocol was established in 1974 and, unbelievably, there is no FDA-approved chemotherapy drug specific to anal cancer – a fact we are working to change. […] Chemotherapies are a class of drugs that kill cancer cells and prevent them from multiplying. […] Anal cancers between stages I-III are often treated with the chemotherapy drugs mitomycin-C and 5-fluorouracil (5-FU) in addition to radiation. […] For stage IV cancers, the NCCN recommends a combination of 5-FU and cisplatin, which is a platinum-based therapy.

• #11 Chemoradiotherapy for Anal Cancer | Cancer Council NSW

  https://www.cancercouncil.com.au/anal-cancer/treatment/chemotherapy/

  This is the most common treatment for anal cancer. It combines a course of radiation therapy with some chemotherapy sessions. It can be very effective and allow you to avoid surgery to remove your anal canal. Chemotherapy makes the cancer cells more sensitive to the radiation therapy. […] For anal cancer, a typical treatment plan might involve a session of radiation therapy every weekday for several weeks, as well as chemotherapy on some days during the first and fifth weeks. This combined approach allows for lower doses of radiation therapy. […] Also known as radiotherapy, this treatment uses targeted radiation, such as x-ray beams, to kill or damage cancer cells. External beam radiation therapy (EBRT) is the most commonly used type of radiation for anal cancer. […] This is the treatment of cancer with anti-cancer (cytotoxic) drugs. It aims to kill cancer cells while doing the least possible damage to healthy cells. For anal cancer, the drugs are usually given into a vein through an intravenous (IV) drip on the first day and then in tablet form for the rest of the treatment. […] Chemoradiation for anal cancer can affect your ability to have children (fertility), which may be temporary or permanent. If you may want to have children in the future, talk to your doctor about what options are available.

• #12 Treatments for stage 1 anal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/anal/treatment/stage-1

  The following are treatment options for stage 1 anal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. […] Chemoradiation is used to treat stage 1 anal cancer when the tumour is too large to be completely removed with a wide local excision. […] During chemoradiation, external radiation therapy is usually given once a day, 5 days a week, for 5 to 6 weeks. Chemotherapy is given every 3 weeks. The chemotherapy drug combination used for stage 1 anal cancer is fluorouracil (also called 5-fluorouracil or 5-FU) and mitomycin. […] You may be offered surgery as treatment for stage 1 anal cancer if the tumour is small and it isn’t in the anal sphincter. […] If treatment with chemoradiation doesn’t destroy all the cancer cells, your healthcare team may offer you surgery to remove the rest of the cancer (called salvage surgery). […] Find out more about surgery for anal cancer.

• #13 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  Because of the link between human papillomavirus (HPV) infection and anal squamous cell carcinoma, vaccination against HPV should be considered as a preventive measure. Screening for anal cancer is recommended for those at high risk, especially persons with HIV infection. […] For localized disease, National Comprehensive Cancer Network (NCCN) guidelines recommend 5-fluorouracil (5-FU), mitomycin, and radiotherapy. 5-FU is infused continuously during days 1-4 and days 29-32. Mitomycin is administered on days 1 and 29 as a bolus infusion. Alternatively, oral capecitabine (eg, 825 mg/m2 twice daily on days 15 weekly for 6 weeks) can be substituted for 5-FU. […] Concurrent multifocal radiotherapy progresses 5 days per week for the full 32 days of treatment, with a total minimum dose of 45 Gy in 25 fractions of 1.8 Gy to the primary cancer, plus additional radiation to the inguinal nodal basins. Additional radiation is recommended for more advanced lesions or known nodal spread. An increased total radiation dose, even up to 65 Gy, and avoiding prolonged breaks are recommended based on limited but compelling data, although increased dose is associated with increased toxicity.

• #14 Anal Cancer Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65778/

  Because of historically high rates of recurrence with colostomy alone, chemoradiation therapy is the preferred approach for patients with anal cancer in the absence of distant metastases. […] The best time to assess a complete clinical response after chemoradiation therapy is generally after 26 weeks because delayed responses are seen. […] Local recurrences and persistent disease after treatment with radiation therapy and chemotherapy or surgery as the primary treatment may be controlled by using the alternate treatment (surgical resection after radiation and vice versa). […] Salvage chemoradiation therapy with fluorouracil and cisplatin plus a radiation boost may avoid permanent colostomy in patients with residual tumor after initial nonoperative therapy. […] The tolerance of patients with HIV and anal carcinoma to standard fluorouracil and mitomycin chemoradiation therapy is not well defined. […] In general, patients with HIV are treated similarly to other patients and have similar outcomes, particularly in the era of highly active antiretroviral therapy (HAART).

• #15 Current Treatments for Anal Cancer: An Overview – HPV Cancers Alliance

  https://hpvca.org/current-treatments-for-anal-cancer-an-overview/

  Other risk factors for recurrence are a tumor size of 5cm or higher and/or lymph node involvement. […] There are numerous current trials of immunotherapies, but the writers emphasize that even more research in this area is needed. […] Although most patients with early-stage disease can be cured with chemoradiation therapy, there is room for improvement in treatments and screenings, and more research is needed to find better treatments for advanced stages of anal cancer. […] SCCA is unique in that chemoradiation alone may preserve the sphincter and be curative. […] The original Nigro regimen of 5-FU and Mitomycin used as radiation sensitizers has been validated in subsequent studies. […] However, phase III trials were not able to establish the superiority of cisplatin over Mitomycin.

• #16 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  Because of the link between human papillomavirus (HPV) infection and anal squamous cell carcinoma, vaccination against HPV should be considered as a preventive measure. Screening for anal cancer is recommended for those at high risk, especially persons with HIV infection. […] For localized disease, National Comprehensive Cancer Network (NCCN) guidelines recommend 5-fluorouracil (5-FU), mitomycin, and radiotherapy. 5-FU is infused continuously during days 1-4 and days 29-32. Mitomycin is administered on days 1 and 29 as a bolus infusion. Alternatively, oral capecitabine (eg, 825 mg/m2 twice daily on days 15 weekly for 6 weeks) can be substituted for 5-FU. […] Concurrent multifocal radiotherapy progresses 5 days per week for the full 32 days of treatment, with a total minimum dose of 45 Gy in 25 fractions of 1.8 Gy to the primary cancer, plus additional radiation to the inguinal nodal basins. Additional radiation is recommended for more advanced lesions or known nodal spread. An increased total radiation dose, even up to 65 Gy, and avoiding prolonged breaks are recommended based on limited but compelling data, although increased dose is associated with increased toxicity.

• #17 Radiation Therapy for Anal Cancer | Anal Cancer Radiation | American Cancer Society

  https://www.cancer.org/cancer/types/anal-cancer/treating/radiation-therapy.html

  Radiation therapy uses high-energy x-rays or particles to kill cancer cells. Depending on the stage of the anal cancer and other factors, radiation therapy might be used: […] Along with chemotherapy as part of the main treatment for most anal cancers (This is called chemoradiation.) […] After surgery if the doctor is concerned that all of the cancer might not have been removed. This might be seen in cancers of the perianal area. […] After surgery for some cancers of the perianal area (anal margin) that are at a high risk of coming back […] To help treat cancer that has come back in the groin lymph nodes after initial treatment […] To help control cancer that has spread, such as to the lungs or to relieve symptoms it causes such as pain or bleeding. […] Different types of radiation therapy can be used to treat anal cancer. There are 2 main types:

• #18 Radiation Therapy for Anal Cancer | Anal Cancer Radiation | American Cancer Society

  https://www.cancer.org/cancer/types/anal-cancer/treating/radiation-therapy.html

  Radiation therapy uses high-energy x-rays or particles to kill cancer cells. Depending on the stage of the anal cancer and other factors, radiation therapy might be used: […] Along with chemotherapy as part of the main treatment for most anal cancers (This is called chemoradiation.) […] After surgery if the doctor is concerned that all of the cancer might not have been removed. This might be seen in cancers of the perianal area. […] After surgery for some cancers of the perianal area (anal margin) that are at a high risk of coming back […] To help treat cancer that has come back in the groin lymph nodes after initial treatment […] To help control cancer that has spread, such as to the lungs or to relieve symptoms it causes such as pain or bleeding. […] Different types of radiation therapy can be used to treat anal cancer. There are 2 main types:

• #19 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  Radiation therapy for anal cancer has historically involved two- or three-dimensional conformal (3DCRT techniques, but intensity-modulated radiation therapy (IMRT) has become the most widely utilized radiation therapy technique for anal cancer, with 3DCRT used in a very small minority of patients. The NCCN currently recommends IMRT over 3DCRT for radiation therapy in anal cancer. […] At the conclusion of the chemoradiation regimen, a re-evaluation by the surgeon is conducted at 8-12 weeks. Subsequent management depends on whether the patient has remission of disease, persistent disease, or progression of disease. […] In refractory metastatic anal cancer, immune checkpoint inhibitors (eg, pembrolizumab, nivolumab) have demonstrated promising efficacy. Research into the use of these agents for refractory cases is ongoing, and clinicians should consider enrolling patients with refractory metastatic anal cancer in one of these clinical trials.

• #20 Radiotherapy for Anal Cancer: Types, Success Rate, Side Effects And More – OncoDaily

  https://oncodaily.com/oncolibrary/radiotherapy/anal-cancer

  Radiotherapy is a key treatment modality for anal cancer, often used in combination with chemotherapy to enhance effectiveness. […] Success rates for radiotherapy in anal cancer are encouraging, with many patients achieving long-term remission. […] In the case of anal cancer, radiotherapy is often combined with chemotherapy (chemoradiation) to increase effectiveness. […] Radiotherapy is used to shrink the tumor, control cancer growth, or eliminate remaining cancer cells after surgery. […] Radiotherapy is highly effective in treating anal cancer, especially when combined with chemotherapy, a treatment approach known as chemoradiation. […] Studies show high success rates, with many patients achieving long-term remission. […] Advances in techniques such as intensity-modulated radiation therapy (IMRT) have improved precision, allowing higher radiation doses to the tumor while minimizing damage to surrounding healthy tissues.

• #21 Radiation Therapy for Anal Cancer | Anal Cancer Radiation | American Cancer Society

  https://www.cancer.org/cancer/types/anal-cancer/treating/radiation-therapy.html

  Intensity-modulated radiation therapy (IMRT) is a form of 3D therapy and the preferred type of EBRT for anal cancer. […] Stereotactic body radiation therapy (SBRT) is a type of radiation that might be used if the anal cancer has come back in the same place or in the nearby lymph nodes. […] Brachytherapy is not commonly used to treat anal cancer. When it is used, it’s usually given as a radiation boost along with external radiation when a tumor isn’t responding to regular chemoradiation (chemo plus external radiation). […] Brachytherapy involves putting small sources of radioactive materials in or near the tumor. It focuses the radiation in the area of the cancer to minimize radiation damage to normal nearby tissue.

• #22 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  Because of the link between human papillomavirus (HPV) infection and anal squamous cell carcinoma, vaccination against HPV should be considered as a preventive measure. Screening for anal cancer is recommended for those at high risk, especially persons with HIV infection. […] For localized disease, National Comprehensive Cancer Network (NCCN) guidelines recommend 5-fluorouracil (5-FU), mitomycin, and radiotherapy. 5-FU is infused continuously during days 1-4 and days 29-32. Mitomycin is administered on days 1 and 29 as a bolus infusion. Alternatively, oral capecitabine (eg, 825 mg/m2 twice daily on days 15 weekly for 6 weeks) can be substituted for 5-FU. […] Concurrent multifocal radiotherapy progresses 5 days per week for the full 32 days of treatment, with a total minimum dose of 45 Gy in 25 fractions of 1.8 Gy to the primary cancer, plus additional radiation to the inguinal nodal basins. Additional radiation is recommended for more advanced lesions or known nodal spread. An increased total radiation dose, even up to 65 Gy, and avoiding prolonged breaks are recommended based on limited but compelling data, although increased dose is associated with increased toxicity.

• #23 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  Because of the link between human papillomavirus (HPV) infection and anal squamous cell carcinoma, vaccination against HPV should be considered as a preventive measure. Screening for anal cancer is recommended for those at high risk, especially persons with HIV infection. […] For localized disease, National Comprehensive Cancer Network (NCCN) guidelines recommend 5-fluorouracil (5-FU), mitomycin, and radiotherapy. 5-FU is infused continuously during days 1-4 and days 29-32. Mitomycin is administered on days 1 and 29 as a bolus infusion. Alternatively, oral capecitabine (eg, 825 mg/m2 twice daily on days 15 weekly for 6 weeks) can be substituted for 5-FU. […] Concurrent multifocal radiotherapy progresses 5 days per week for the full 32 days of treatment, with a total minimum dose of 45 Gy in 25 fractions of 1.8 Gy to the primary cancer, plus additional radiation to the inguinal nodal basins. Additional radiation is recommended for more advanced lesions or known nodal spread. An increased total radiation dose, even up to 65 Gy, and avoiding prolonged breaks are recommended based on limited but compelling data, although increased dose is associated with increased toxicity.

• #24 Chemotherapy for anal cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/anal-cancer/treatment/anal-chemotherapy

  Chemotherapy uses anti cancer drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. […] Common chemotherapy drugs for advanced anal cancer are carboplatin and paclitaxel. […] You usually have chemotherapy combined with radiotherapy (chemoradiotherapy) as your main treatment for anal cancer that hasn’t spread. […] You usually have chemotherapy on its own for advanced anal cancer. This is to shrink or slow down the cancer. It can also relieve your symptoms. […] You may have one drug or a combination of drugs to treat advanced anal cancer. The most common types of chemotherapy drugs are: carboplatin and paclitaxel, fluorouracil and cisplatin with folinic acid, or with docetaxel. […] You have the chemotherapy drugs for advanced anal cancer into your bloodstream (intravenously).

• #25 Chemotherapy for anal cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/anal-cancer/treatment/anal-chemotherapy

  Chemotherapy uses anti cancer drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. […] Common chemotherapy drugs for advanced anal cancer are carboplatin and paclitaxel. […] You usually have chemotherapy combined with radiotherapy (chemoradiotherapy) as your main treatment for anal cancer that hasn’t spread. […] You usually have chemotherapy on its own for advanced anal cancer. This is to shrink or slow down the cancer. It can also relieve your symptoms. […] You may have one drug or a combination of drugs to treat advanced anal cancer. The most common types of chemotherapy drugs are: carboplatin and paclitaxel, fluorouracil and cisplatin with folinic acid, or with docetaxel. […] You have the chemotherapy drugs for advanced anal cancer into your bloodstream (intravenously).

• #26 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  Because of the link between human papillomavirus (HPV) infection and anal squamous cell carcinoma, vaccination against HPV should be considered as a preventive measure. Screening for anal cancer is recommended for those at high risk, especially persons with HIV infection. […] For localized disease, National Comprehensive Cancer Network (NCCN) guidelines recommend 5-fluorouracil (5-FU), mitomycin, and radiotherapy. 5-FU is infused continuously during days 1-4 and days 29-32. Mitomycin is administered on days 1 and 29 as a bolus infusion. Alternatively, oral capecitabine (eg, 825 mg/m2 twice daily on days 15 weekly for 6 weeks) can be substituted for 5-FU. […] Concurrent multifocal radiotherapy progresses 5 days per week for the full 32 days of treatment, with a total minimum dose of 45 Gy in 25 fractions of 1.8 Gy to the primary cancer, plus additional radiation to the inguinal nodal basins. Additional radiation is recommended for more advanced lesions or known nodal spread. An increased total radiation dose, even up to 65 Gy, and avoiding prolonged breaks are recommended based on limited but compelling data, although increased dose is associated with increased toxicity.

• #27 Anal Cancer: Pharmacologic Treatment – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/ddi/anal-cancer-pharmacologic-treatment/

  Chemotherapy is the recommended primary treatment for both local and metastatic anal cancer. Although there is currently no chemotherapy approved by the US Food and Drug Administration (FDA) to treat anal cancer, off-label chemotherapies have been commonly used to treat the disease since the 1970s. […] The NCCN recommends platinum-based chemotherapy, specifically combined regimens of carboplatin and paclitaxel, as first-line agents for treating metastatic anal cancer. […] To prevent recurrence of carcinomas at the primary site following metastasis, the NCCN also recommends chemotherapy with either 5-FU or capecitabine plus radiation therapy following first-line platinum-based chemotherapy. […] Immunotherapy stimulates the body’s immune system to attack cancerous cells. This new class of medications has shown promise for treating anal cancer. Multiple clinical trials are currently exploring the use of different immune checkpoint inhibitors as potential first-line or second-line treatments for metastatic anal cancer.

• #28 Chemotherapy for anal cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/anal-cancer/treatment/anal-chemotherapy

  Chemotherapy uses anti cancer drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. […] Common chemotherapy drugs for advanced anal cancer are carboplatin and paclitaxel. […] You usually have chemotherapy combined with radiotherapy (chemoradiotherapy) as your main treatment for anal cancer that hasn’t spread. […] You usually have chemotherapy on its own for advanced anal cancer. This is to shrink or slow down the cancer. It can also relieve your symptoms. […] You may have one drug or a combination of drugs to treat advanced anal cancer. The most common types of chemotherapy drugs are: carboplatin and paclitaxel, fluorouracil and cisplatin with folinic acid, or with docetaxel. […] You have the chemotherapy drugs for advanced anal cancer into your bloodstream (intravenously).

• #29 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  According to the NCCN, local excision alone may be adequate treatment for carefully selected patients with superficially invasive SCC of the anus. […] If there is a reasonable expectation of adequate margins (1 cm), then surgery can be attempted, as complete excision will eliminate the need for chemotherapy and radiation therapy. If the margins are inadequate, re-excision may be attempted or the above radiation/chemotherapy regimen should be initiated. […] Historically, treatment of anal cancer was primarily surgical, with abdominoperineal resection (APR) and permanent end-colostomy as the primary option. That treatment was associated with substantial morbidity and a relatively high recurrence rate. […] With the impressive results from nonsurgical treatment (chemoradiation) and its elimination of the need for end-colostomy, APR has become only sparingly used in the treatment of anal cancer.

• #30 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  According to the NCCN, local excision alone may be adequate treatment for carefully selected patients with superficially invasive SCC of the anus. […] If there is a reasonable expectation of adequate margins (1 cm), then surgery can be attempted, as complete excision will eliminate the need for chemotherapy and radiation therapy. If the margins are inadequate, re-excision may be attempted or the above radiation/chemotherapy regimen should be initiated. […] Historically, treatment of anal cancer was primarily surgical, with abdominoperineal resection (APR) and permanent end-colostomy as the primary option. That treatment was associated with substantial morbidity and a relatively high recurrence rate. […] With the impressive results from nonsurgical treatment (chemoradiation) and its elimination of the need for end-colostomy, APR has become only sparingly used in the treatment of anal cancer.

• #31

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-cancer

  Anal cancer is raremuch less common than cancer of the colon or rectum. […] Prevention and screening of high-risk populations are key parts in decreasing the rates of anal cancer and effectively treating the disease when it occurs. […] A recent study (ANCHOR) shows that treatment of precancerous lesions in high-risk populations will decrease the risk of anal cancer in the future. […] Treatment of anal cancer includes: Local excision by surgery (for smaller tumors that do not involve the sphincter muscle or that can be removed with clear margins), Chemotherapy and radiation (Nigro protocol), Surgical removal of the rectum and anus with colostomy (for recurrent cancer or for a cancer that does not respond to chemotherapy and radiation). […] Most anal cancers are cured with chemotherapy and radiation. If caught early, many cancers that come back after nonsurgical treatment are treated effectively with surgery.

• #32 Surgery for Anal Cancer | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/anal/anal-cancer-treatment/surgery-anal

  MSKs team of colorectal surgeons, including Emmanouil Pappou, are experts at removing anal cancer. They will do everything possible to help you keep your quality of life. […] Radiation therapy is often the main treatment for anal cancer, but your doctor may talk with you about surgery. This treatment option is based on the tumors size and location. […] The 2 main types of surgery for anal cancer are: Local resection and Abdominoperineal resection. […] A local resection is for small tumors in the anal margin (outer layer of the anus) that have not spread. Your surgeon removes the tumor and a little tissue around it to get all the cancer cells. […] Chemoradiation is now the main treatment for anal cancer. In the past, it was abdominoperineal resection (APR). APR is used for anal cancer that did not respond to radiation or chemotherapy, or that came back after treatment.

• #33 Anal Cancer – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/surgery/general-and-gastrointestinal-surgery/colorectal-and-intestines-disorders/anal-cancer

  Patients have different options when it comes to anal cancer treatment. Often they receive a combination of surgical and medical treatments: […] Colon and rectal surgeons at BWH are internationally recognized surgical specialists who are faculty at Harvard Medical School and have years of experience in anal cancer surgery. They have perfected progressive surgical procedures including: […] Sphincter sparing local resection: If the cancer is small and has not spread, your surgeon may do a local resection. The surgeon removes the tumor along with surrounding tissue. Usually, the sphincter is not damaged. This means you will still be able to pass stool in the normal way. […] Abdominoperineal resection: Your surgeon removes your anus and your rectum. Without an anus, you will no longer be able to pass stool in the same way. The surgeon makes a permanent opening in your abdomen, called a stoma. A disposable plastic bag is attached to the stoma to collect the stool as it passes through the opening in your abdomen. This is called a colostomy.

• #34 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  According to the NCCN, local excision alone may be adequate treatment for carefully selected patients with superficially invasive SCC of the anus. […] If there is a reasonable expectation of adequate margins (1 cm), then surgery can be attempted, as complete excision will eliminate the need for chemotherapy and radiation therapy. If the margins are inadequate, re-excision may be attempted or the above radiation/chemotherapy regimen should be initiated. […] Historically, treatment of anal cancer was primarily surgical, with abdominoperineal resection (APR) and permanent end-colostomy as the primary option. That treatment was associated with substantial morbidity and a relatively high recurrence rate. […] With the impressive results from nonsurgical treatment (chemoradiation) and its elimination of the need for end-colostomy, APR has become only sparingly used in the treatment of anal cancer.

• #35 Anal Cancer Treatment Options | The Anal Cancer Foundation

  https://www.analcancerfoundation.org/treatment/

  Radiation for anal cancer involves using an external beam of radiation that is directed toward the cancer location to shrink tumors and kill cancer cells. […] Individuals with stage IV or recurrent cancer may receive radiation in locations where the cancer has spread. […] Although anal cancer is primarily treated with chemotherapy and radiation protocols, there may be times when surgery is used. […] Another type of surgery is used for an ostomy. An ostomy is a surgically created opening in the abdominal wall used for the removal of bodily waste, i.e. stool or poop. […] The standard of care to treat anal cancer stages I-III is combined chemoradiation therapy, otherwise known as the ‘Nigro Protocol’. […] The standard of care to treat stage IV anal cancer is chemotherapy. […] Immunotherapies are a developing classification of interventions for cancer that seek to harness the power of an individual’s immune system.

• #36 Anal Cancer: Pharmacologic Treatment – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/ddi/anal-cancer-pharmacologic-treatment/

  Although no immunotherapy agent has yet obtained FDA approval for the treatment of anal cancer, the NCCN guidelines recommend nivolumab and pembrolizumab as second-line options for patients whose metastatic anal cancer has progressed during first-line platinum-based chemotherapy. […] The use of nivolumab or pembrolizumab is also recommended when patients opt to avoid APR following recurrent disease, although no published data support this practice. […] Nivolumab is an antibody that blocks the interaction between the programmed death-1 (PD-1) receptors found on T cells and its ligands, programmed death ligand -1 (PD-L1) and PD-L2. By blocking this interaction, nivolumab prevents the inhibition of active T-cell tumor surveillance and thus results in anti-tumor activity. […] Pembrolizumab is another antibody that blocks the interaction between PD-1 receptors and their ligands to induce antitumor activity. Pembrolizumab is recommended for off-label use as a second-line therapy for metastatic anal cancer.

• #37 Anal Cancer: Pharmacologic Treatment – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/ddi/anal-cancer-pharmacologic-treatment/

  Although no immunotherapy agent has yet obtained FDA approval for the treatment of anal cancer, the NCCN guidelines recommend nivolumab and pembrolizumab as second-line options for patients whose metastatic anal cancer has progressed during first-line platinum-based chemotherapy. […] The use of nivolumab or pembrolizumab is also recommended when patients opt to avoid APR following recurrent disease, although no published data support this practice. […] Nivolumab is an antibody that blocks the interaction between the programmed death-1 (PD-1) receptors found on T cells and its ligands, programmed death ligand -1 (PD-L1) and PD-L2. By blocking this interaction, nivolumab prevents the inhibition of active T-cell tumor surveillance and thus results in anti-tumor activity. […] Pembrolizumab is another antibody that blocks the interaction between PD-1 receptors and their ligands to induce antitumor activity. Pembrolizumab is recommended for off-label use as a second-line therapy for metastatic anal cancer.

• #38 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  Radiation therapy for anal cancer has historically involved two- or three-dimensional conformal (3DCRT techniques, but intensity-modulated radiation therapy (IMRT) has become the most widely utilized radiation therapy technique for anal cancer, with 3DCRT used in a very small minority of patients. The NCCN currently recommends IMRT over 3DCRT for radiation therapy in anal cancer. […] At the conclusion of the chemoradiation regimen, a re-evaluation by the surgeon is conducted at 8-12 weeks. Subsequent management depends on whether the patient has remission of disease, persistent disease, or progression of disease. […] In refractory metastatic anal cancer, immune checkpoint inhibitors (eg, pembrolizumab, nivolumab) have demonstrated promising efficacy. Research into the use of these agents for refractory cases is ongoing, and clinicians should consider enrolling patients with refractory metastatic anal cancer in one of these clinical trials.

• #39 Anal Cancer: Pharmacologic Treatment – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/ddi/anal-cancer-pharmacologic-treatment/

  Although no immunotherapy agent has yet obtained FDA approval for the treatment of anal cancer, the NCCN guidelines recommend nivolumab and pembrolizumab as second-line options for patients whose metastatic anal cancer has progressed during first-line platinum-based chemotherapy. […] The use of nivolumab or pembrolizumab is also recommended when patients opt to avoid APR following recurrent disease, although no published data support this practice. […] Nivolumab is an antibody that blocks the interaction between the programmed death-1 (PD-1) receptors found on T cells and its ligands, programmed death ligand -1 (PD-L1) and PD-L2. By blocking this interaction, nivolumab prevents the inhibition of active T-cell tumor surveillance and thus results in anti-tumor activity. […] Pembrolizumab is another antibody that blocks the interaction between PD-1 receptors and their ligands to induce antitumor activity. Pembrolizumab is recommended for off-label use as a second-line therapy for metastatic anal cancer.

• #40 Treatments for anal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/anal/treatment

  Your healthcare team will create a treatment plan just for you. The plan is based on your health and specific information about the cancer. What you want is also important when planning treatment. When deciding which treatments to offer for anal cancer, your healthcare team will consider: […] Chemotherapy given with radiation therapy during the same time period (chemoradiation) is the main treatment for early-stage anal cancer. Chemotherapy and radiation therapy may also be used on their own. Surgery is used to treat anal cancer if the cancer doesn’t respond to chemoradiation or for a very small tumour. […] Surgery is the main treatment for stage 0 anal cancer. […] Stage 1 anal cancer is often treated with surgery or chemoradiation. […] Chemoradiation is the main treatment for stage 2 anal cancer.

• #41 Anal Cancer Treatment – NCI

  https://www.cancer.gov/types/anal/patient/anal-treatment-pdq

  Anal cancer is a type of cancer that forms in the tissues of the anus. […] There are different types of treatment for people with anal cancer. […] The following types of treatment are used: Surgery, Radiation therapy, Chemotherapy. […] Treatment of stage 0 is usually local resection. […] Treatment of stage I, stage II, and stage III anal cancer may include: local resection for tumors of the skin around the outside of the anus and tumors inside the anal opening that do not involve the anal sphincter, external beam radiation therapy with chemotherapy, radiation therapy alone, abdominoperineal resection, if cancer remains or comes back after treatment with radiation therapy and chemotherapy, or other options that may include treatment with additional chemoradiation therapy, chemotherapy alone, or immunotherapy.

• #42 Treatments for anal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/anal/treatment

  Your healthcare team will create a treatment plan just for you. The plan is based on your health and specific information about the cancer. What you want is also important when planning treatment. When deciding which treatments to offer for anal cancer, your healthcare team will consider: […] Chemotherapy given with radiation therapy during the same time period (chemoradiation) is the main treatment for early-stage anal cancer. Chemotherapy and radiation therapy may also be used on their own. Surgery is used to treat anal cancer if the cancer doesn’t respond to chemoradiation or for a very small tumour. […] Surgery is the main treatment for stage 0 anal cancer. […] Stage 1 anal cancer is often treated with surgery or chemoradiation. […] Chemoradiation is the main treatment for stage 2 anal cancer.

• #43 Anal Cancer – Treatment

  https://ruesch.georgetown.edu/analcancertreatment/

  Having the human immunodeficiency virus can affect treatment of anal cancer. […] New types of treatment are being tested in clinical trials. […] Treatment for anal cancer may cause side effects. […] Patients may want to think about taking part in a clinical trial. […] Treatment of stage 0 is usually local resection. […] Treatment of stage I anal cancer may include the following: Local resection, External-beam radiation therapy with or without chemotherapy, Internal radiation therapy, Abdominoperineal resection. […] Treatment of stage II anal cancer may include the following: Local resection, External-beam radiation therapy with chemotherapy, Internal radiation therapy, Abdominoperineal resection. […] Treatment of stage IIIA anal cancer may include the following: External-beam radiation therapy with chemotherapy, Internal radiation therapy, Abdominoperineal resection.

• #44 Treatments for stage 1 anal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/anal/treatment/stage-1

  The following are treatment options for stage 1 anal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. […] Chemoradiation is used to treat stage 1 anal cancer when the tumour is too large to be completely removed with a wide local excision. […] During chemoradiation, external radiation therapy is usually given once a day, 5 days a week, for 5 to 6 weeks. Chemotherapy is given every 3 weeks. The chemotherapy drug combination used for stage 1 anal cancer is fluorouracil (also called 5-fluorouracil or 5-FU) and mitomycin. […] You may be offered surgery as treatment for stage 1 anal cancer if the tumour is small and it isn’t in the anal sphincter. […] If treatment with chemoradiation doesn’t destroy all the cancer cells, your healthcare team may offer you surgery to remove the rest of the cancer (called salvage surgery). […] Find out more about surgery for anal cancer.

• #45 Treatments for stage 1 anal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/anal/treatment/stage-1

  The following are treatment options for stage 1 anal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. […] Chemoradiation is used to treat stage 1 anal cancer when the tumour is too large to be completely removed with a wide local excision. […] During chemoradiation, external radiation therapy is usually given once a day, 5 days a week, for 5 to 6 weeks. Chemotherapy is given every 3 weeks. The chemotherapy drug combination used for stage 1 anal cancer is fluorouracil (also called 5-fluorouracil or 5-FU) and mitomycin. […] You may be offered surgery as treatment for stage 1 anal cancer if the tumour is small and it isn’t in the anal sphincter. […] If treatment with chemoradiation doesn’t destroy all the cancer cells, your healthcare team may offer you surgery to remove the rest of the cancer (called salvage surgery). […] Find out more about surgery for anal cancer.

• #46 Treatments for stage 1 anal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/anal/treatment/stage-1

  The following are treatment options for stage 1 anal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. […] Chemoradiation is used to treat stage 1 anal cancer when the tumour is too large to be completely removed with a wide local excision. […] During chemoradiation, external radiation therapy is usually given once a day, 5 days a week, for 5 to 6 weeks. Chemotherapy is given every 3 weeks. The chemotherapy drug combination used for stage 1 anal cancer is fluorouracil (also called 5-fluorouracil or 5-FU) and mitomycin. […] You may be offered surgery as treatment for stage 1 anal cancer if the tumour is small and it isn’t in the anal sphincter. […] If treatment with chemoradiation doesn’t destroy all the cancer cells, your healthcare team may offer you surgery to remove the rest of the cancer (called salvage surgery). […] Find out more about surgery for anal cancer.

• #47 Treatments for anal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/anal/treatment

  Chemoradiation is the main treatment for stage 3 anal cancer. […] Stage 4 anal cancer may be treated with chemotherapy or surgery. […] Recurrent anal cancer may be treated with chemoradiation, surgery or chemotherapy. […] Anal cancer is often treated with chemotherapy given in the same time period as radiation therapy. […] Anal cancer is often treated with chemoradiation, which is radiation therapy given in the same time period as chemotherapy. […] Anal cancer is sometimes treated with surgery. […] Follow-up is an important part of care for anal cancer. It often involves regular tests and visits with the healthcare team.

• #48 Treatments for stage 1 anal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/anal/treatment/stage-1

  The following are treatment options for stage 1 anal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. […] Chemoradiation is used to treat stage 1 anal cancer when the tumour is too large to be completely removed with a wide local excision. […] During chemoradiation, external radiation therapy is usually given once a day, 5 days a week, for 5 to 6 weeks. Chemotherapy is given every 3 weeks. The chemotherapy drug combination used for stage 1 anal cancer is fluorouracil (also called 5-fluorouracil or 5-FU) and mitomycin. […] You may be offered surgery as treatment for stage 1 anal cancer if the tumour is small and it isn’t in the anal sphincter. […] If treatment with chemoradiation doesn’t destroy all the cancer cells, your healthcare team may offer you surgery to remove the rest of the cancer (called salvage surgery). […] Find out more about surgery for anal cancer.

• #49 Anal Cancer Treatment – NCI

  https://www.cancer.gov/types/anal/patient/anal-treatment-pdq

  Anal cancer is a type of cancer that forms in the tissues of the anus. […] There are different types of treatment for people with anal cancer. […] The following types of treatment are used: Surgery, Radiation therapy, Chemotherapy. […] Treatment of stage 0 is usually local resection. […] Treatment of stage I, stage II, and stage III anal cancer may include: local resection for tumors of the skin around the outside of the anus and tumors inside the anal opening that do not involve the anal sphincter, external beam radiation therapy with chemotherapy, radiation therapy alone, abdominoperineal resection, if cancer remains or comes back after treatment with radiation therapy and chemotherapy, or other options that may include treatment with additional chemoradiation therapy, chemotherapy alone, or immunotherapy.

• #50 Anal Cancer Treatment – NCI

  https://www.cancer.gov/types/anal/patient/anal-treatment-pdq

  Treatment of stage IV anal cancer may include: palliative surgery to relieve symptoms and improve quality of life, palliative radiation therapy, palliative chemotherapy with or without radiation therapy. […] Treatment of recurrent anal cancer may include: radiation therapy and chemotherapy, for recurrence after surgery, surgery, for recurrence after radiation therapy and/or chemotherapy. […] In general, treatment for people who have anal cancer and HIV is similar to treatment for other people, and these patients have similar outcomes. However, this treatment can further damage the weakened immune systems of people who have HIV.

• #51 Anal Cancer | Vanderbilt-Ingram Cancer Center

  https://vicc.org/cancer-info/adult-anal-cancer

  Treatment of stage IV anal cancer may include: palliative surgery to relieve symptoms and improve quality of life, palliative radiation therapy, palliative chemotherapy with or without radiation therapy, a clinical trial of immunotherapy. […] Treatment of recurrent anal cancer may include: radiation therapy and chemotherapy, for recurrence after surgery, surgery, for recurrence after radiation therapy and/or chemotherapy, a clinical trial of radiation therapy with chemotherapy and radiosensitizers, a clinical trial of chemotherapy options, a clinical trial of immunotherapy.

• #52 Anal Cancer | Vanderbilt-Ingram Cancer Center

  https://vicc.org/cancer-info/adult-anal-cancer

  Treatment of stage IV anal cancer may include: palliative surgery to relieve symptoms and improve quality of life, palliative radiation therapy, palliative chemotherapy with or without radiation therapy, a clinical trial of immunotherapy. […] Treatment of recurrent anal cancer may include: radiation therapy and chemotherapy, for recurrence after surgery, surgery, for recurrence after radiation therapy and/or chemotherapy, a clinical trial of radiation therapy with chemotherapy and radiosensitizers, a clinical trial of chemotherapy options, a clinical trial of immunotherapy.

• #53 Anal Cancer: Pharmacologic Treatment – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/ddi/anal-cancer-pharmacologic-treatment/

  Chemotherapy is the recommended primary treatment for both local and metastatic anal cancer. Although there is currently no chemotherapy approved by the US Food and Drug Administration (FDA) to treat anal cancer, off-label chemotherapies have been commonly used to treat the disease since the 1970s. […] The NCCN recommends platinum-based chemotherapy, specifically combined regimens of carboplatin and paclitaxel, as first-line agents for treating metastatic anal cancer. […] To prevent recurrence of carcinomas at the primary site following metastasis, the NCCN also recommends chemotherapy with either 5-FU or capecitabine plus radiation therapy following first-line platinum-based chemotherapy. […] Immunotherapy stimulates the body’s immune system to attack cancerous cells. This new class of medications has shown promise for treating anal cancer. Multiple clinical trials are currently exploring the use of different immune checkpoint inhibitors as potential first-line or second-line treatments for metastatic anal cancer.

• #54 Anal Cancer: Pharmacologic Treatment – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/ddi/anal-cancer-pharmacologic-treatment/

  Although no immunotherapy agent has yet obtained FDA approval for the treatment of anal cancer, the NCCN guidelines recommend nivolumab and pembrolizumab as second-line options for patients whose metastatic anal cancer has progressed during first-line platinum-based chemotherapy. […] The use of nivolumab or pembrolizumab is also recommended when patients opt to avoid APR following recurrent disease, although no published data support this practice. […] Nivolumab is an antibody that blocks the interaction between the programmed death-1 (PD-1) receptors found on T cells and its ligands, programmed death ligand -1 (PD-L1) and PD-L2. By blocking this interaction, nivolumab prevents the inhibition of active T-cell tumor surveillance and thus results in anti-tumor activity. […] Pembrolizumab is another antibody that blocks the interaction between PD-1 receptors and their ligands to induce antitumor activity. Pembrolizumab is recommended for off-label use as a second-line therapy for metastatic anal cancer.

• #55 Anal Cancer Treatment – NCI

  https://www.cancer.gov/types/anal/patient/anal-treatment-pdq

  Treatment of stage IV anal cancer may include: palliative surgery to relieve symptoms and improve quality of life, palliative radiation therapy, palliative chemotherapy with or without radiation therapy. […] Treatment of recurrent anal cancer may include: radiation therapy and chemotherapy, for recurrence after surgery, surgery, for recurrence after radiation therapy and/or chemotherapy. […] In general, treatment for people who have anal cancer and HIV is similar to treatment for other people, and these patients have similar outcomes. However, this treatment can further damage the weakened immune systems of people who have HIV.

• #56 Anal Cancer | Vanderbilt-Ingram Cancer Center

  https://vicc.org/cancer-info/adult-anal-cancer

  Treatment of stage IV anal cancer may include: palliative surgery to relieve symptoms and improve quality of life, palliative radiation therapy, palliative chemotherapy with or without radiation therapy, a clinical trial of immunotherapy. […] Treatment of recurrent anal cancer may include: radiation therapy and chemotherapy, for recurrence after surgery, surgery, for recurrence after radiation therapy and/or chemotherapy, a clinical trial of radiation therapy with chemotherapy and radiosensitizers, a clinical trial of chemotherapy options, a clinical trial of immunotherapy.

• #57 Anal Cancer | Vanderbilt-Ingram Cancer Center

  https://vicc.org/cancer-info/adult-anal-cancer

  Treatment of stage IV anal cancer may include: palliative surgery to relieve symptoms and improve quality of life, palliative radiation therapy, palliative chemotherapy with or without radiation therapy, a clinical trial of immunotherapy. […] Treatment of recurrent anal cancer may include: radiation therapy and chemotherapy, for recurrence after surgery, surgery, for recurrence after radiation therapy and/or chemotherapy, a clinical trial of radiation therapy with chemotherapy and radiosensitizers, a clinical trial of chemotherapy options, a clinical trial of immunotherapy.

• #58 Anal Cancer | Vanderbilt-Ingram Cancer Center

  https://vicc.org/cancer-info/adult-anal-cancer

  Treatment of stage IV anal cancer may include: palliative surgery to relieve symptoms and improve quality of life, palliative radiation therapy, palliative chemotherapy with or without radiation therapy, a clinical trial of immunotherapy. […] Treatment of recurrent anal cancer may include: radiation therapy and chemotherapy, for recurrence after surgery, surgery, for recurrence after radiation therapy and/or chemotherapy, a clinical trial of radiation therapy with chemotherapy and radiosensitizers, a clinical trial of chemotherapy options, a clinical trial of immunotherapy.

• #59 Anal Cancer Treatment – NCI

  https://www.cancer.gov/types/anal/patient/anal-treatment-pdq

  Treatment of stage IV anal cancer may include: palliative surgery to relieve symptoms and improve quality of life, palliative radiation therapy, palliative chemotherapy with or without radiation therapy. […] Treatment of recurrent anal cancer may include: radiation therapy and chemotherapy, for recurrence after surgery, surgery, for recurrence after radiation therapy and/or chemotherapy. […] In general, treatment for people who have anal cancer and HIV is similar to treatment for other people, and these patients have similar outcomes. However, this treatment can further damage the weakened immune systems of people who have HIV.

• #60 Anal Cancer Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65778/

  Because of historically high rates of recurrence with colostomy alone, chemoradiation therapy is the preferred approach for patients with anal cancer in the absence of distant metastases. […] The best time to assess a complete clinical response after chemoradiation therapy is generally after 26 weeks because delayed responses are seen. […] Local recurrences and persistent disease after treatment with radiation therapy and chemotherapy or surgery as the primary treatment may be controlled by using the alternate treatment (surgical resection after radiation and vice versa). […] Salvage chemoradiation therapy with fluorouracil and cisplatin plus a radiation boost may avoid permanent colostomy in patients with residual tumor after initial nonoperative therapy. […] The tolerance of patients with HIV and anal carcinoma to standard fluorouracil and mitomycin chemoradiation therapy is not well defined. […] In general, patients with HIV are treated similarly to other patients and have similar outcomes, particularly in the era of highly active antiretroviral therapy (HAART).

• #61 Anal Cancer: Pharmacologic Treatment – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/ddi/anal-cancer-pharmacologic-treatment/

  The NCCN guidelines recommend 5-FU or capecitabine with concurrent radiation as adjuvant therapy, assuming patients opt not to undergo APR and have not previously received radiation therapy to the groin. […] Patients with locally recurrent or persistent disease after 6 months, APR may be necessary to avoid recurrence. At this stage, EBRT is also strongly recommended for patients who have not previously received it as part of primary therapy. […] Following primary treatment of local anal cancer, surveillance and follow-up treatments are necessary. Typically, patients are re-evaluated between 8 to 12 weeks after completion of chemotherapy plus radiation therapy and determined to have remission of disease, persistent disease, or progressive disease. […] Patients living with HIV/AIDs often experience worse treatment outcomes due to additional burden from HIV-associated cancers (eg, Kaposi sarcoma), more frequent infections with atypical micro-organisms, and other causes. However, concomitant treatment with antiretroviral therapy may improve patient outcomes and promote the suppression of HIV viral load.

• #62 Anal Cancer Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65778/

  Because of historically high rates of recurrence with colostomy alone, chemoradiation therapy is the preferred approach for patients with anal cancer in the absence of distant metastases. […] The best time to assess a complete clinical response after chemoradiation therapy is generally after 26 weeks because delayed responses are seen. […] Local recurrences and persistent disease after treatment with radiation therapy and chemotherapy or surgery as the primary treatment may be controlled by using the alternate treatment (surgical resection after radiation and vice versa). […] Salvage chemoradiation therapy with fluorouracil and cisplatin plus a radiation boost may avoid permanent colostomy in patients with residual tumor after initial nonoperative therapy. […] The tolerance of patients with HIV and anal carcinoma to standard fluorouracil and mitomycin chemoradiation therapy is not well defined. […] In general, patients with HIV are treated similarly to other patients and have similar outcomes, particularly in the era of highly active antiretroviral therapy (HAART).

• #63 Effective treatment of anal cancer in the elderly with low-dose chemoradiotherapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2361984/

  Chemoradiotherapy (CRT) is accepted as the standard initial treatment for squamous cell anal cancer. […] This paper reports the results of a modified regimen for this group of patients. […] The treatment was well tolerated. […] This is a well-tolerated regimen for elderly/poor performance patients with anal cancer, which can achieve high rates of local control and survival. […] Chemoradiotherapy (CRT) is accepted as the standard initial treatment for squamous anal cancer with surgery used as salvage treatment for recurrent or persistent disease. […] In routine clinical practice, however, clinicians face the problem of deciding the best treatment option for elderly patients who are frail, suffer from significant medical co-morbid conditions or who are for other reasons considered unfit to undergo standard (full-dose) chemoradiation.

• #64 Effective treatment of anal cancer in the elderly with low-dose chemoradiotherapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2361984/

  Chemoradiotherapy (CRT) is accepted as the standard initial treatment for squamous cell anal cancer. […] This paper reports the results of a modified regimen for this group of patients. […] The treatment was well tolerated. […] This is a well-tolerated regimen for elderly/poor performance patients with anal cancer, which can achieve high rates of local control and survival. […] Chemoradiotherapy (CRT) is accepted as the standard initial treatment for squamous anal cancer with surgery used as salvage treatment for recurrent or persistent disease. […] In routine clinical practice, however, clinicians face the problem of deciding the best treatment option for elderly patients who are frail, suffer from significant medical co-morbid conditions or who are for other reasons considered unfit to undergo standard (full-dose) chemoradiation.

• #65 Anal Cancer: Pharmacologic Treatment – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/ddi/anal-cancer-pharmacologic-treatment/

  Geriatric patients often cannot tolerate mitomycin or other chemotherapeutic agents. The NCCN instead recommends a combination of weekly cisplatin and daily 5-FU on days of radiation therapy. Alternatively, patients may opt for capecitabine plus radiation therapy or radiation therapy without additional chemotherapy. […] Up-to-date guidelines for the management of patients with anal cancer are available, including the 2023 NCCN Guideline for Anal Cancer.

• #66 Anal cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/bowel-cancer/anal-cancer

  Surgery is not often used to treat anal cancer. This is because chemoradiation is often the only treatment needed. You may be offered surgery if you have a very small tumour in the anal margin. This will only be if the surgeon can remove it without affecting how you pass poo (stools). […] You may have radiotherapy on its own if you are not well enough to have chemoradiation. Radiotherapy can also be used to help with symptoms if the cancer has spread. […] You may have chemotherapy on its own if the cancer has spread to other parts of the body. It may help to control the cancer and improve symptoms. […] Your cancer doctor may invite you to take part in a clinical trial.

• #67 Effective treatment of anal cancer in the elderly with low-dose chemoradiotherapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2361984/

  The aim of this paper is to present the results of this protocol. […] The protocol used in our patients was developed from the phase II studies reported by Nigros group and our own experience of using a total of 30Gy to microscopic disease and a boost dose of 20Gy to macroscopic disease without a planned gap in our standard regimen. […] To our knowledge, our study is the first to report the results of a protocol of low-dose radiotherapy combined with chemotherapy specifically designed for use in elderly patients and/or poor performance patients. […] The availability of a low-toxicity, relatively uncomplicated regimen means that more patients can be offered treatment, which not only improves symptoms but also offers the prospect of long-term tumour control.

• #68 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  Radiation therapy for anal cancer has historically involved two- or three-dimensional conformal (3DCRT techniques, but intensity-modulated radiation therapy (IMRT) has become the most widely utilized radiation therapy technique for anal cancer, with 3DCRT used in a very small minority of patients. The NCCN currently recommends IMRT over 3DCRT for radiation therapy in anal cancer. […] At the conclusion of the chemoradiation regimen, a re-evaluation by the surgeon is conducted at 8-12 weeks. Subsequent management depends on whether the patient has remission of disease, persistent disease, or progression of disease. […] In refractory metastatic anal cancer, immune checkpoint inhibitors (eg, pembrolizumab, nivolumab) have demonstrated promising efficacy. Research into the use of these agents for refractory cases is ongoing, and clinicians should consider enrolling patients with refractory metastatic anal cancer in one of these clinical trials.

• #69 Current Treatments for Anal Cancer: An Overview – HPV Cancers Alliance

  https://hpvca.org/current-treatments-for-anal-cancer-an-overview/

  The surgeons role is critical in the baseline evaluation and determination of response to therapy. […] As tumors will continue to regress after chemoradiation is complete, the recommendation is that follow up begin 8-12 weeks after completion of treatment. […] Lesions with clinical evidence of growth at 3 months may be considered for biopsy. […] Approximately 10-30% of patients will have either persistent or recurrent disease for whom abdominal perineal resection (APR) is recommended. […] The ACT II trial showed that 21% of tumors still present at 11 weeks had regressed by 26 weeks after starting treatment, and this supports more time for regression before salvage surgery. […] Novel treatment options are needed for surgically unresectable or metastatic patients even though therapeutic options have increased in the past 5 years.

• #70 Current Treatments for Anal Cancer: An Overview – HPV Cancers Alliance

  https://hpvca.org/current-treatments-for-anal-cancer-an-overview/

  The surgeons role is critical in the baseline evaluation and determination of response to therapy. […] As tumors will continue to regress after chemoradiation is complete, the recommendation is that follow up begin 8-12 weeks after completion of treatment. […] Lesions with clinical evidence of growth at 3 months may be considered for biopsy. […] Approximately 10-30% of patients will have either persistent or recurrent disease for whom abdominal perineal resection (APR) is recommended. […] The ACT II trial showed that 21% of tumors still present at 11 weeks had regressed by 26 weeks after starting treatment, and this supports more time for regression before salvage surgery. […] Novel treatment options are needed for surgically unresectable or metastatic patients even though therapeutic options have increased in the past 5 years.

• #71 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  Radiation therapy for anal cancer has historically involved two- or three-dimensional conformal (3DCRT techniques, but intensity-modulated radiation therapy (IMRT) has become the most widely utilized radiation therapy technique for anal cancer, with 3DCRT used in a very small minority of patients. The NCCN currently recommends IMRT over 3DCRT for radiation therapy in anal cancer. […] At the conclusion of the chemoradiation regimen, a re-evaluation by the surgeon is conducted at 8-12 weeks. Subsequent management depends on whether the patient has remission of disease, persistent disease, or progression of disease. […] In refractory metastatic anal cancer, immune checkpoint inhibitors (eg, pembrolizumab, nivolumab) have demonstrated promising efficacy. Research into the use of these agents for refractory cases is ongoing, and clinicians should consider enrolling patients with refractory metastatic anal cancer in one of these clinical trials.

• #72 Anal cancer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-adults/anal-cancer/

  Surgery is a less common treatment option for anal cancer. Its usually only considered if the tumour is small and can be easily removed, or if chemoradiation hasnt worked. […] If chemoradiation has been unsuccessful or the cancer has returned after treatment, a more complex operation called an abdominoperineal resection may be recommended. […] After your course of treatment ends, youll need to have regular follow-up appointments to monitor your recovery and check for any signs of the cancer returning.

• #73 Treatments for anal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/anal/treatment

  Chemoradiation is the main treatment for stage 3 anal cancer. […] Stage 4 anal cancer may be treated with chemotherapy or surgery. […] Recurrent anal cancer may be treated with chemoradiation, surgery or chemotherapy. […] Anal cancer is often treated with chemotherapy given in the same time period as radiation therapy. […] Anal cancer is often treated with chemoradiation, which is radiation therapy given in the same time period as chemotherapy. […] Anal cancer is sometimes treated with surgery. […] Follow-up is an important part of care for anal cancer. It often involves regular tests and visits with the healthcare team.

• #74 Anal Cancer Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/2500052-treatment

  A wide variety of complications can affect the anal cancer patient, including the short-term adverse effects of active chemotherapy and long-term risks of radiation exposure. […] Strategies for prevention of anal squamous cell carcinoma consist of vaccination against HPV and management of anal intraepithelial neoplasia (AIN). […] The use of topical creams in the setting of close long-term follow-up is considered appropriate for AIN lesions. Topical 5% imiquimod cream is considered appropriate for anal margin AIN lesions, as is 5% 5-fluorouracil (5-FU) cream. Good responses are reported; adverse effects are common but typically of low severity. […] Targeted biopsy and destruction of the lesions, when visible, are considered the preferred methods of control for AIN.

• #75 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=34&contentid=18995-1

  Another type of EBRT is called sterostatic body radiation therapy. It may be used when cancer comes back in the same place, to treat nearby lymph nodes, and in areas like the brain. You may only be given 1 to 5 treatments. […] Most side effects start a few weeks into treatment and go away over time after treatment ends. Here are some common short-term side effects of radiation for anal cancer: Skin irritation, redness, blistering, itching, or burning in the treated area around the anus; Anal irritation and pain; Diarrhea, sometimes with some rectal bleeding; Discomfort when having a bowel movement; Nausea and vomiting; An urgent need to urinate, burning with urination; Bladder pain; Tiredness (fatigue); Low blood cell counts. […] Here are some possible long-term side effects of radiation for anal cancer: Scar tissue that forms and causes problems with bowel movements or bowel obstructions; Inability to have children (infertility); Impotence (erectile dysfunction); Damage to the pelvic bones, increasing the risk for fractures or breaks; Damage to blood vessels in the rectum, which can cause rectal pain and bleeding (chronic radiation proctitis); Vaginal dryness and narrowing and shortening of the vagina (vaginal stenosis); Connections (fistulas) appear between the bowel and vagina.

• #76 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=34&contentid=18995-1

  Another type of EBRT is called sterostatic body radiation therapy. It may be used when cancer comes back in the same place, to treat nearby lymph nodes, and in areas like the brain. You may only be given 1 to 5 treatments. […] Most side effects start a few weeks into treatment and go away over time after treatment ends. Here are some common short-term side effects of radiation for anal cancer: Skin irritation, redness, blistering, itching, or burning in the treated area around the anus; Anal irritation and pain; Diarrhea, sometimes with some rectal bleeding; Discomfort when having a bowel movement; Nausea and vomiting; An urgent need to urinate, burning with urination; Bladder pain; Tiredness (fatigue); Low blood cell counts. […] Here are some possible long-term side effects of radiation for anal cancer: Scar tissue that forms and causes problems with bowel movements or bowel obstructions; Inability to have children (infertility); Impotence (erectile dysfunction); Damage to the pelvic bones, increasing the risk for fractures or breaks; Damage to blood vessels in the rectum, which can cause rectal pain and bleeding (chronic radiation proctitis); Vaginal dryness and narrowing and shortening of the vagina (vaginal stenosis); Connections (fistulas) appear between the bowel and vagina.

• #77 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=34&contentid=18995-1

  Another type of EBRT is called sterostatic body radiation therapy. It may be used when cancer comes back in the same place, to treat nearby lymph nodes, and in areas like the brain. You may only be given 1 to 5 treatments. […] Most side effects start a few weeks into treatment and go away over time after treatment ends. Here are some common short-term side effects of radiation for anal cancer: Skin irritation, redness, blistering, itching, or burning in the treated area around the anus; Anal irritation and pain; Diarrhea, sometimes with some rectal bleeding; Discomfort when having a bowel movement; Nausea and vomiting; An urgent need to urinate, burning with urination; Bladder pain; Tiredness (fatigue); Low blood cell counts. […] Here are some possible long-term side effects of radiation for anal cancer: Scar tissue that forms and causes problems with bowel movements or bowel obstructions; Inability to have children (infertility); Impotence (erectile dysfunction); Damage to the pelvic bones, increasing the risk for fractures or breaks; Damage to blood vessels in the rectum, which can cause rectal pain and bleeding (chronic radiation proctitis); Vaginal dryness and narrowing and shortening of the vagina (vaginal stenosis); Connections (fistulas) appear between the bowel and vagina.

• #78 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=34&contentid=18995-1

  Another type of EBRT is called sterostatic body radiation therapy. It may be used when cancer comes back in the same place, to treat nearby lymph nodes, and in areas like the brain. You may only be given 1 to 5 treatments. […] Most side effects start a few weeks into treatment and go away over time after treatment ends. Here are some common short-term side effects of radiation for anal cancer: Skin irritation, redness, blistering, itching, or burning in the treated area around the anus; Anal irritation and pain; Diarrhea, sometimes with some rectal bleeding; Discomfort when having a bowel movement; Nausea and vomiting; An urgent need to urinate, burning with urination; Bladder pain; Tiredness (fatigue); Low blood cell counts. […] Here are some possible long-term side effects of radiation for anal cancer: Scar tissue that forms and causes problems with bowel movements or bowel obstructions; Inability to have children (infertility); Impotence (erectile dysfunction); Damage to the pelvic bones, increasing the risk for fractures or breaks; Damage to blood vessels in the rectum, which can cause rectal pain and bleeding (chronic radiation proctitis); Vaginal dryness and narrowing and shortening of the vagina (vaginal stenosis); Connections (fistulas) appear between the bowel and vagina.

• #79 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=34&contentid=18995-1

  It’s important to know how the radiation will work and what side effects you might have. Ask what can be done to help prevent or ease them. Also know which side effects are short-term and which could occur later on and affect the rest of your life. Many of the side effects during treatment can be treated, so it’s important to tell your healthcare team about your side effects.

• #80 Anal Cancer Symptoms, Diagnosis and Treatment | Froedtert & MCW

  https://www.froedtert.com/anal-cancer-symptoms-treatment

  Once you are diagnosed, your radiation team will make a plan to deliver very precise, image-guided radiation that is needed to cure anal cancer, even when the cancer is locally advanced. Intensity modulated radiation therapy (IMRT) is an advanced method that can deliver higher doses of radiation more precisely to the tumor while avoiding surrounding tissue. Targeting the radiation precisely to the tumor helps prevent side effects and maximize elimination of the tumor. IMRT can mean fewer side effects from radiation therapy and better quality of life. […] Patients with early, as well as locally advanced and metastatic anal cancer, will benefit from the expertise of our colorectal surgeons and our medical oncology team, which has access to the latest drug therapies for treating anal cancer.

• #81 Recent Advances in the Management of Anal Cancer

  https://www.mdpi.com/2227-9032/11/23/3010

  Current and future clinical trials are evaluating treatments for SCCA including immunotherapy alone or in combination regimens, radiotherapies, targeted treatments and novel agents. […] Another critical aspect of current research in SCCA is the personalization of CRT and immunotherapies based on molecular characterization and biomarkers such as the programmed death-ligand 1 (PD-L1), epidermal growth factor receptor (EGFR) and circulating tumor DNA.

• #82 Current Treatments for Anal Cancer: An Overview – HPV Cancers Alliance

  https://hpvca.org/current-treatments-for-anal-cancer-an-overview/

  In recent years, there have been improvements in the treatment of anal cancer. […] The review provides extensive and important information about recent developments in treatment for anal cancer patients. […] IMRT radiation is preferred. […] Image-guided radiation therapy with daily cone beam computed tomography is recommended because it provides more targeted treatment with lower levels of toxicity that improve both short- and long-term side effects from treatment. […] Vaginal dilators used during and/or after radiation may reduce long-term vaginal stenosis. […] One dose of Mitomycin significantly reduces toxicity compared to two doses. […] Oral chemotherapy, capecitabine, has been shown to have less toxicity than infusional 5-FU. […] The risk of recurrence is increased by lack of adherence to the treatment protocol such as lowering doses of radiation or chemotherapy in the last week of treatment and/or by delaying the start of treatment by more than 42 days.

• #83 Current Treatments for Anal Cancer: An Overview – HPV Cancers Alliance

  https://hpvca.org/current-treatments-for-anal-cancer-an-overview/

  In recent years, there have been improvements in the treatment of anal cancer. […] The review provides extensive and important information about recent developments in treatment for anal cancer patients. […] IMRT radiation is preferred. […] Image-guided radiation therapy with daily cone beam computed tomography is recommended because it provides more targeted treatment with lower levels of toxicity that improve both short- and long-term side effects from treatment. […] Vaginal dilators used during and/or after radiation may reduce long-term vaginal stenosis. […] One dose of Mitomycin significantly reduces toxicity compared to two doses. […] Oral chemotherapy, capecitabine, has been shown to have less toxicity than infusional 5-FU. […] The risk of recurrence is increased by lack of adherence to the treatment protocol such as lowering doses of radiation or chemotherapy in the last week of treatment and/or by delaying the start of treatment by more than 42 days.

• #84 Current Treatments for Anal Cancer: An Overview – HPV Cancers Alliance

  https://hpvca.org/current-treatments-for-anal-cancer-an-overview/

  In recent years, there have been improvements in the treatment of anal cancer. […] The review provides extensive and important information about recent developments in treatment for anal cancer patients. […] IMRT radiation is preferred. […] Image-guided radiation therapy with daily cone beam computed tomography is recommended because it provides more targeted treatment with lower levels of toxicity that improve both short- and long-term side effects from treatment. […] Vaginal dilators used during and/or after radiation may reduce long-term vaginal stenosis. […] One dose of Mitomycin significantly reduces toxicity compared to two doses. […] Oral chemotherapy, capecitabine, has been shown to have less toxicity than infusional 5-FU. […] The risk of recurrence is increased by lack of adherence to the treatment protocol such as lowering doses of radiation or chemotherapy in the last week of treatment and/or by delaying the start of treatment by more than 42 days.

• #85 Current Treatments for Anal Cancer: An Overview – HPV Cancers Alliance

  https://hpvca.org/current-treatments-for-anal-cancer-an-overview/

  In recent years, there have been improvements in the treatment of anal cancer. […] The review provides extensive and important information about recent developments in treatment for anal cancer patients. […] IMRT radiation is preferred. […] Image-guided radiation therapy with daily cone beam computed tomography is recommended because it provides more targeted treatment with lower levels of toxicity that improve both short- and long-term side effects from treatment. […] Vaginal dilators used during and/or after radiation may reduce long-term vaginal stenosis. […] One dose of Mitomycin significantly reduces toxicity compared to two doses. […] Oral chemotherapy, capecitabine, has been shown to have less toxicity than infusional 5-FU. […] The risk of recurrence is increased by lack of adherence to the treatment protocol such as lowering doses of radiation or chemotherapy in the last week of treatment and/or by delaying the start of treatment by more than 42 days.

• #86 Current Treatments for Anal Cancer: An Overview – HPV Cancers Alliance

  https://hpvca.org/current-treatments-for-anal-cancer-an-overview/

  The surgeons role is critical in the baseline evaluation and determination of response to therapy. […] As tumors will continue to regress after chemoradiation is complete, the recommendation is that follow up begin 8-12 weeks after completion of treatment. […] Lesions with clinical evidence of growth at 3 months may be considered for biopsy. […] Approximately 10-30% of patients will have either persistent or recurrent disease for whom abdominal perineal resection (APR) is recommended. […] The ACT II trial showed that 21% of tumors still present at 11 weeks had regressed by 26 weeks after starting treatment, and this supports more time for regression before salvage surgery. […] Novel treatment options are needed for surgically unresectable or metastatic patients even though therapeutic options have increased in the past 5 years.

• #87 Recent Advances in the Management of Anal Cancer

  https://www.mdpi.com/2227-9032/11/23/3010

  Current and future clinical trials are evaluating treatments for SCCA including immunotherapy alone or in combination regimens, radiotherapies, targeted treatments and novel agents. […] Another critical aspect of current research in SCCA is the personalization of CRT and immunotherapies based on molecular characterization and biomarkers such as the programmed death-ligand 1 (PD-L1), epidermal growth factor receptor (EGFR) and circulating tumor DNA.

• #88 Recent Advances in the Management of Anal Cancer

  https://www.mdpi.com/2227-9032/11/23/3010

  Current and future clinical trials are evaluating treatments for SCCA including immunotherapy alone or in combination regimens, radiotherapies, targeted treatments and novel agents. […] Another critical aspect of current research in SCCA is the personalization of CRT and immunotherapies based on molecular characterization and biomarkers such as the programmed death-ligand 1 (PD-L1), epidermal growth factor receptor (EGFR) and circulating tumor DNA.

• #89 Recent Advances in the Management of Anal Cancer

  https://www.mdpi.com/2227-9032/11/23/3010

  Current and future clinical trials are evaluating treatments for SCCA including immunotherapy alone or in combination regimens, radiotherapies, targeted treatments and novel agents. […] Another critical aspect of current research in SCCA is the personalization of CRT and immunotherapies based on molecular characterization and biomarkers such as the programmed death-ligand 1 (PD-L1), epidermal growth factor receptor (EGFR) and circulating tumor DNA.

• #90 Recent Advances in the Management of Anal Cancer

  https://www.mdpi.com/2227-9032/11/23/3010

  Current and future clinical trials are evaluating treatments for SCCA including immunotherapy alone or in combination regimens, radiotherapies, targeted treatments and novel agents. […] Another critical aspect of current research in SCCA is the personalization of CRT and immunotherapies based on molecular characterization and biomarkers such as the programmed death-ligand 1 (PD-L1), epidermal growth factor receptor (EGFR) and circulating tumor DNA.

• #91 Anal Cancer | Harold C. Simmons Comprehensive Cancer Center | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/anal-cancer/

  Early-stage anal cancer: Some small tumors can be removed without the risk of damaging the anal sphincter muscles that control bowel movements. The surgeon removes these tumors and a small margin of nearby healthy tissue to ensure that all cancer is removed. […] Late-stage anal cancer: Sometimes, chemoradiation is not enough to destroy anal tumors. For more advanced cancers, the surgeon removes the tumors and surrounding tissue where cancer has spread. These areas might include the anus, rectum, and part of the colon, depending on where the cancer has spread. The surgeon attaches the remaining colon to an opening in the abdomen to allow stool to exit the body into a bag in a procedure known as a colostomy. […] As a medical research institution, UT Southwestern conducts frequent clinical trials, giving our patients access to the newest treatments for anal cancer. Patients should speak with their doctors about the availability of clinical trials.

• #92 Current Treatments for Anal Cancer: An Overview – HPV Cancers Alliance

  https://hpvca.org/current-treatments-for-anal-cancer-an-overview/

  Given the clinical activity observed with checkpoint inhibitor therapy in advanced anal cancer, several studies are evaluating its role in locally advanced anal cancer. […] Immunotherapy remains a well-tolerated and effective recent advance in the management of metastatic anal cancer, and there are a number of important ongoing trials in this area. […] Investigational advances in anal cancer also help advanced research options in other HPV-related malignancies like cervical cancer, head and neck cancer, and penile, vaginal, and vulvar cancer.

• #93 Anal Cancer | Vanderbilt-Ingram Cancer Center

  https://vicc.org/cancer-info/adult-anal-cancer

  Treatment of stage IV anal cancer may include: palliative surgery to relieve symptoms and improve quality of life, palliative radiation therapy, palliative chemotherapy with or without radiation therapy, a clinical trial of immunotherapy. […] Treatment of recurrent anal cancer may include: radiation therapy and chemotherapy, for recurrence after surgery, surgery, for recurrence after radiation therapy and/or chemotherapy, a clinical trial of radiation therapy with chemotherapy and radiosensitizers, a clinical trial of chemotherapy options, a clinical trial of immunotherapy.

• #94 Anal Cancer Treatment | Baptist Health Miami Cancer Institute

  https://baptisthealth.net/services/cancer-care/miami-cancer-institute/our-approach/adult-cancers/gastrointestinal-cancers/anal-cancer/treatment

  Every patient at Miami Cancer Institute receives a personalized treatment plan put together by our team of medical oncologists, surgical oncologists, radiation oncologists and interventional oncologists. […] Anal cancer treatment often consists of a combination of chemotherapy and radiation therapy, also referred to as chemoradiotherapy. This has emerged as the preferred method of treatment for squamous cell carcinoma localized to the anal canal because it can cure many patients, while preserving the function of the anal sphincter. Surgery is typically only used if there is residual or recurrent cancer after the completion of chemotherapy and radiation therapy treatments. […] The radiation oncology department at Miami Cancer Institute is well-known for having access to every form of radiation treatment available today, all under one roof. […] Proton therapy is a highly specialized treatment that directs proton particles toward tumors. The goal of treatment is to destroy cancer cells while largely sparing healthy tissue and decreasing the risk of side effects.

• #95 Anal cancer explained: symptoms, diagnosis and treatment | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/9-common-anal-cancer-questions.h00-159464790.html

  Most early-stage anal cancers can be cured with chemoradiation alone. […] The standard treatment for anal cancer is chemoradiation alone if the cancer hasn’t spread. […] Most patients with anal cancer that hasn’t spread can be cured with chemoradiation alone. That’s when chemotherapy is given in tandem with radiation therapy to make the radiation more effective. […] We cure over 80% of our patients with stage I or stage II anal cancer, and about 60% of our patients with stage III anal cancer. […] Stage IV anal cancer usually cannot be cured, but it can be treated. […] Where you go first for anal cancer treatment matters. You want to make sure you’re going someplace with a lot of experience in treating anal cancer. […] Our focus is not only on curing the cancer but on personalizing the treatment so it’s less toxic than the standard therapy you might otherwise get from your local oncologist.

• #96 Anal cancer explained: symptoms, diagnosis and treatment | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/9-common-anal-cancer-questions.h00-159464790.html

  Most early-stage anal cancers can be cured with chemoradiation alone. […] The standard treatment for anal cancer is chemoradiation alone if the cancer hasn’t spread. […] Most patients with anal cancer that hasn’t spread can be cured with chemoradiation alone. That’s when chemotherapy is given in tandem with radiation therapy to make the radiation more effective. […] We cure over 80% of our patients with stage I or stage II anal cancer, and about 60% of our patients with stage III anal cancer. […] Stage IV anal cancer usually cannot be cured, but it can be treated. […] Where you go first for anal cancer treatment matters. You want to make sure you’re going someplace with a lot of experience in treating anal cancer. […] Our focus is not only on curing the cancer but on personalizing the treatment so it’s less toxic than the standard therapy you might otherwise get from your local oncologist.

• #97 Anal Cancer – Symptoms, Causes & Treatment | OSF Cancer Institute | OSF HealthCare

  https://www.osfhealthcare.org/services/specialties/cancer/conditions-treatments/conditions/anal

  Chemotherapy. Chemo is the use of strong medicines that kill cancer cells. For the treatment of anal cancer, its often given as intravenously for four or five days in a row. The aim of the medicine is to shrink the tumor. Chemo combined with radiation therapy is used to treat, and even cure, most anal cancers without surgery. […] Surgery. Surgery is done to remove the tumor, while leaving as much of the anus as possible intact. In most cases, surgery for anal cancer isn’t needed. If surgery is an option for you, know exactly what will be done and how stool will come out of your body after surgery. […] When caught early, anal cancer can be cured with treatment. According to the American Cancer Society, the five-year anal cancer survival rate is about 83% when it hasn’t spread and 67% when it has spread to other areas in the same region as the anus.

• #98

  https://winshipcancer.emory.edu/cancer-types-and-treatments/anal-cancer/

  Anal cancer is relatively rare. At Winship Cancer Institute of Emory University, we have the expertise to treat your cancer and minimize difficult side effects. […] Treating it requires a level of expertise you wont easily find at community cancer centers. […] Fortunately, the gastrointestinal oncology team at Winship Cancer Institute of Emory University specializes in the diagnosis, treatment and research of anal cancer. […] But research institutions, including Winship, are making progress every day in the treatment of anal cancer and symptom management. […] Even more than with other cancers, its imperative that patients with anal cancer seek treatment at a center that has lots of experience with the disease. […] Your individual treatment plan depends on an accurate and precise diagnosis.

• #99

  https://winshipcancer.emory.edu/cancer-types-and-treatments/anal-cancer/treatment.php

  As Georgias only NCI-designated Comprehensive Cancer Center, Winship patients have access to anal cancer treatment thats not available elsewhere. […] Anal cancer treatment has come a long way in recent decades, providing patients with lifesaving options that have fewer side effects. […] Because every case of anal cancer is different, there is no single anal cancer treatment plan that works for everyone. […] Once your personalized anal cancer treatment plan is created, your team will discuss it with you and treatment at Winship will be scheduled right away. […] Winship is Georgias only National Cancer Institutedesignated Comprehensive Cancer Center, and we participate in hundreds of clinical trials each year. […] At Winship, we offer the most comprehensive array of anal cancer treatment options in Georgia and the expertise to treat this complex disease.

• #100 Recent Advances in the Management of Anal Cancer

  https://www.mdpi.com/2227-9032/11/23/3010

  Current and future clinical trials are evaluating treatments for SCCA including immunotherapy alone or in combination regimens, radiotherapies, targeted treatments and novel agents. […] Another critical aspect of current research in SCCA is the personalization of CRT and immunotherapies based on molecular characterization and biomarkers such as the programmed death-ligand 1 (PD-L1), epidermal growth factor receptor (EGFR) and circulating tumor DNA.

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