What are the treatment protocols for limited localized anal cancer?

Updated: Apr 07, 2020
  • Author: Jeffrey B VanDeusen, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Stage I-III (any T, any N, M0):

Current primary recommendations for non-metastatic anal cancer include concurrent chemotherapy and radiation therapy. [1] Common drugs include 5-fluorouracil (5-FU) and mitomycin; capecitabine may be substituted for 5-FU. There is some controversy regarding substituting cisplatin for mitomycin in limited-stage disease (conflicting clinical trial results); the National Comprehensive Cancer Network (NCCN) lists 5FU plus cisplatin and radiation therapy as a category 2B rcommendation. [2]

Mitomycin + 5-FU + radiotherapy [2, 3]

  • 5-FU 1000 mg/m 2/day IV continuous infusion on days 1-4 and 29-32 (maximum daily dose of 5-FU of 2000 mg/day) plus  mitomycin 10 mg/m 2 IV bolus on days 1 and 29 (maximum 20 mg per dose)
  • Radiotherapy (RT) should be included with all stages of disease; minimum of 45 Gy given over 5wk

  • Additional RT of 9-14 Gy may be considered for patients with T3, T4, or node-positive disease or in those with residual disease after an initial 45 Gy

Mitomycin + capecitabine + RT [2]

  • Capecitabine 825 mg/m 2 PO BID, Monday–Friday, on each day that RT is given, throughout the duration of RT (typically 28 treatment days)  plus  mitomycin 10 mg/m 2 days 1 and 29 plus  concurrent RT  or
  • Capecitabine 825 mg/m 2 PO BID days 1–5 weekly x 6 weeks plus  mitomycin 12 mg/m 2 IV bolus day 1 plus concurrent RT

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