Squamous cell carcinoma of the anal canal historically has been treated with
abdominoperineal resection, resulting in high rates of morbidity and local recurrence. Pioneering work led to the finding that
radiation therapy (RT) combined with
5-fluorouracil (5-FU) and
mitomycin results in high rates of local control and disease-free and
colostomy-free survival without surgery. Prospective randomized trials from Europe and the United States have shown the superiority of RT,
5-FU, and
mitomycin over 1) RT alone, 2) RT with 5-FU, and 3) neoadjuvant
cisplatin/5-FU with concurrent radiation,
cisplatin, and 5-FU. At present, RT with 5-FU and
mitomycin is the standard of care for
anal cancer patients. Recent advances include the integration of positron emission tomography into staging,
radiation treatment planning and monitoring, and the use of intensity modulated RT. European randomized trials are further evaluating the role of
cisplatin in the neoadjuvant, concurrent, and adjuvant settings, as well as radiation dose escalation. Other studies are evaluating the use of
capecitabine,
oxaliplatin, and the anti-
epidermal growth factor receptor agent
cetuximab with RT in this
malignancy.