Given the significant risk of recurrence after chemoradiation for locally advanced anal carcinoma, should resection be considered (with or without neoadjuvant treatment) in select cases?

At other sites we consider locally advanced disease and high risk of recurrence a contraindication for organ preservation. Would surgery improve likelihood of local control in locally advanced anal cancer? From 98-11 T4N0 – 37 percent LRF T3N+ – 44 percent LRF T4N+ – 60 percent LRF

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Mednet MemberInvited Expert

Radiation Oncology · Washington University School of Medicine

Answered on

Interesting question. As a practical matter, many of the tumors that start out unresectable get replaced with dense fibrosis--and, therefore remain major surgical challenges even if there's residual cancer within the fibrosis.

Many people argue that, since anal cancer can be slow to manifest complete response, one should follow these patients and delay biopsy well beyond the usual (for other diseases) 1-2 months post tx. I would suggest a narrow exception to that. If a tumor had initially been unresectable or borderline resectable pre tx and an examination 1-2 months post tx revels an area of suspicious nodularity that is now mobile, then one should consider a biopsy and surgery if positive. If you wait on a case like that, the resectability window that your treatment had opened could close on you. That was put into the NCCN guidelines as a footnote.