Treatment of Anal Cancer When Definitive Chemoradiotherapy Does Not Achieve Complete Response
Clinical Scenario
This protocol addresses patients with stage II–III anal margin cancer or stage I–III anal canal cancer in whom definitive chemoradiotherapy has been the initial treatment and disease progression has been confirmed.
Previous Line: Goal Not Reached
The prior treatment — definitive chemoradiotherapy — aims to achieve a complete response, defined as the absence of tumour and ulceration on clinical assessment at 26 weeks after completion of treatment.
When this endpoint is not met and disease progression is confirmed, escalation to the next step is indicated.
Next Step: Salvage Approach
When disease progression occurs after chemoradiotherapy, salvage surgery is recommended — the mainstay being a specific type of abdomino-perineal excision, with further surgical and reconstructive considerations detailed in the full protocol.
References
DOI: 10.1016/j.annonc.2021.06.015
- Stage II-III anal margin
- Stage I-III anal canal
- If disease progression occurs, salvage surgery is recommended.
- The mainstay of salvage is an extra-levator APE.
- The mainstay of salvage surgery is an APE, but more radical exenterative operations can be considered to achieve an R0 resection [III, C].
- Perineal plastic reconstruction with musculo-cutaneous flaps should be considered in almost all cases [IV, C].
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