Anal carcinoma: Clinical practice guidelines in oncology™

The panel believes that a multidisciplinary approach, including physicians from gastroenterology, medical oncology, surgical oncology, radiation oncology, and radiology, is necessary for treating patients with anal carcinoma. Recommendations for the primary treatment of anal margin and anal canal cancer are very similar and include 5-FU/mitomycin-based RT, although small, well-differentiated anal margin lesions can be treated with margin-negative local excision alone. Follow-up clinical evaluations are recommended for all patients with anal carcinoma because salvage is possible. Patients with biopsy-proven evidence of locoregional progressive disease after primary treatment should undergo an APR. After complete remission of disease, patients with a local recurrence should be treated with an APR with groin dissection if they have evidence of inguinal nodal metastasis, and patients with a regional recurrence in the inguinal nodes can be treated with an inguinal node dissection, with consideration of RT with or without chemotherapy, if limited prior RT to the groin was given. Patients with evidence of extrapelvic metastatic disease should be treated with cisplatin-based chemotherapy or enrolled in a clinical trial. The panel endorses the concept that treating patients in a clinical trial has priority over standard or accepted therapy.