Chemoradiotherapy for anal squamous cell carcinoma

In the guidelines on American National Comprehensive Cancer Network, local excision with adequate margin is recommended as a primary treatment for patients with T1, N0, and well-differentiated anal margin cancers. Otherwise, concurrent chemotherapy using mitomycin C (10 mg/m², day 1 and 29) and 5-FU (1,000 mg/m²/day, continuous intravenous infusion, day 1-4 and 29-32) with radiation (total dose of 45-59 Gy) is the recommended primary treatment for all other stages of non-metastatic anal margin and anal canal cancer. Abdominoperineal resection is performed for patients with local recurrent diseases or residual tumor after chemoradiotherapy. Chemotherapy, using cisplatin (100 mg/m², day 2) and 5-FU (1, 000 mg/m²/day, day 1-5) every four weeks, is recommended for patients with distant metastases, and radiotherapy can also be given for the local control of symptomatic anal lesions. Abdominoperineal resection has been performed in Japan; however, use of chemoradiotherapy is expected to increase for patients with anal squamous cell carcinoma. Clarification of the correct positioning of chemoradiotherapy using cisplatin, and the development of treatment using oral anticancer agents, are expected in the future by a clinical trial now in progress.