Management of early anal cancer: need for guidelines and standardisation
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The optimal management of early squamous cell carcinoma of the anal canal (AC) is yet to be determined. This study investigated current practice in the management of early AC.
A patterns of care survey was completed by Australian surgeons and radiation oncologists. Specific topics addressed were as follows: geographical location of practice, staging of disease, treatment approaches to T1N0 tumours and grade 3 anal intra-epithelial neoplasia (AIN3) lesions, radiotherapy planning, toxicities, follow-up and clinical trial involvement.
Sixty-four responses were obtained. For the management of T1N0 disease, half the respondents recommended standard dose chemo-radiotherapy (CRT) and one third recommended wide local excision (WLE). For the management of AIN3, half recommended WLE while a quarter advocated observation.
This study reveals a significant variation in the management of early AC. The development of guidelines specific to the treatment of early AC could standardise treatment while further research is required to define the optimal management of T1N0 AC and AIN.
KeywordsAnal cancer Anal intra-epithelial neoplasia Chemo-radiotherapy
Thank you to Mo Hammoud for constructing and managing the online survey. Thank you to General Surgeons Australia and the Royal Australian and New Zealand College of Radiologists, Faculty of Radiation Oncology for distributing the survey to their members.
The authors declare that no funding was received.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study, formal consent is not required.
The research related to human participants was in keeping with all relevant national regulations and institutional policies and was performed in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ ethics committee.
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