ABSTRACT

The current mainstay of treatment for squamous-cell carcinoma (SCCa) of the anal canal is combined chemotherapy and radiation (CRT). In the 1970s, Nigro and his coworkers demonstrated that CRT produced local control rates similar to those of surgery, while offering the additional advantage of sphincter preservation (1-4). Several subsequent studies (including large, prospective randomized trials) have confirmed the superiority of combined CRT, compared to RT alone, in achieving local control and improving survival (5). A randomized prospective trial by the Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group suggested that in large tumors (equal to or greater than 5 cm), the addition of mitomycin C improves local control (83% complete response rate), colostomy-free survival, and disease-free survival, although it is associated with greater hematologic toxicity (6).