Carcinoma of the Anus: A Concise Review of Loco- Regional Therapy

Carcinoma of the anus comprises a small portion of patients afflicted with gastrointestinal malignancies. Due to its anatomical location, patients tend to present with signs and symptoms localized to the anal canal or perianal skin. Typically presenting in advanced ages, carcinoma of the anus has been identified as a typical site of squamous cell carcinoma (SCC). While aggressive, cancer, carcinoma of the anus is one of the first anatomical sites successfully treated with organ preservation. Since the 1980's therapy for anal cancer has evolved to continuous radiation management with concurrent chemo radiotherapy (CRT) excluding routine induction chemotherapy, maintenance chemotherapy or radiation boost therapy. Intensity-modulated radiation therapy (IMRT) has demonstrated improvement in the radiation toxicity profile and advances in technology have enabled larger variations in patient set-up and dose-fraction delivery. 5-Fluorouracil (5-FU) and mitomycin (MMC) have been established as the standard systemic therapies, but pro-drugs of these agents have been tested in the treatment of pelvic malignancies. Biomarkers of human papillomavirus (HPV) status and imaging biomarkers select patients at higher risk of relapse or residual disease after conventional therapy, potentiating personally modified therapies in the future.