Current Management of Anal Canal Cancer

Combined-modality therapy consisting of radiation therapy and 5-fluorouracil plus mitomycin remains the standard treatment for localized anal canal cancer, permitting preservation of organ function and achieving high response and survival rates. Current trials are evaluating the ability to deliver higher doses of radiation therapy over shorter intervals. Currently, the most common indication for radical surgery is failure of chemoradiation. Metastatic disease is less responsive to chemoradiation treatment. Neoadjuvant and adjuvant strategies are being evaluated, and additional drugs including capecitabine, irinotecan, and oxaliplatin are being assessed in treatment of localized and advanced disease.