Current treatment for localized anal carcinoma

Chemoradiation represents the standard of care for most patients with localized squamous cell carcinoma of the anal canal. This article reviews randomized trials and recent studies on chemoradiation for anal cancer.

A recent randomized trial showed that patients treated with induction 5-fluorouracil/cisplatin followed by concurrent 5-fluorouracil/cisplatin and radiotherapy had a higher colostomy rate than patients treated with concurrent 5-fluorouracil/mitomycin C and radiotherapy. It remains unclear whether this difference in the rate of colostomy was due to the chemotherapy agents, the use of induction therapy in the 5-fluorouracil/cisplatin arm, or other factors. Recent studies have started to evaluate intensity modulated radiation therapy for anal cancer, in an effort to reduce acute and long-term toxicity from radiotherapy.

The role of cisplatin in anal cancer is not completely clear, although an ongoing randomized trial (Anal Cancer Trial II) may help clarify the role of cisplatin. Studies on tumor biology and patient genetics are warranted to identify patients that are most likely to benefit from newer locoregional and systemic therapies. Intensity modulated radiation therapy appears to be a promising approach for reducing treatment-related toxicity in anal cancer patients. The Radiation Therapy Oncology Group (RTOG) is conducting a phase II trial evaluating the multi-institutional feasibility of intensity modulated radiation therapy for anal cancer.