How do you manage early stage anal or anal margin cancer that is locally excised with negative but close margins when going back for wider margins would require an APR?

I've seen this scenario several times when a patient has an excisional biopsy (the surgeon doesn't think it is cancer) and leaves behind a positive or close margin. After properly staging the patient with pelvic MRI, I typically recommend adjuvant chemoradiation since they are at risk for recurrence...

Also relevant to this discussion is the current U.K. ACT3 study which will generate some prospective data in this group in the following schema:

”ACT3: a prospective non-randomised phase II trial which will evaluate a treatment plan in patients with early, small tumours who have undergone surgery (l...

These are important cases to discuss in a multidisciplinary setting. I agree with everything previously posted by @Dr. First Last, @Dr. First Last, @Dr. First Last, and @Dr. First Last. We are still waiting for the results of the U.K. ACT3 study. @Dr. First Last’s EA2182 DECREASE (NCT04166318) study...

An alternative option is observation for everyone with small (<1cm excised) tumors when the margins are negative. Patients with positive margins can also be followed because of the overall favorable biology. This is a locoregional disease and the salvage option is as effective as initial treatment b...