Current treatment of anal squamous cell carcinoma

The primary aim of anal cancer treatment is loco-regional control with preservation of anal function. Phase III trials consistently demonstrate radiotherapy with concurrent 5FU and mitomycin (MMC) chemoradiation is the standard of care for anal cancer. Salvage surgery is associated with considerable morbidity and requires specialised input. With current sophisticated radiological staging and the ability to spare critical normal tissues with intensity-modulated radiotherapy, a "one-size-fits-all" approach is probably inappropriate. Radiotherapy dose-escalation and intensification of the concurrent chemotherapy might improve local control, but may also adversely affect colostomy-free survival. Integration of biologic therapy with conventional chemotherapies looks hopeful in the future.