How would you manage locally advanced anal cancer patients with PET positive para-aortic lymph nodes?

I would recommend a curative attempt in such patients, based on the following 5 considerations:

1. Para-aortic spread, although lumped together as stage IV in the AJCC 7th edition, is not the same as distant hematogenous spread. There is no magical line of demarcation at L4-L5 at which the lymph node...

I cannot help you with data. Inherently, this is going to be bad. The French have trials for anal cancer using sequential therapy. We know that the intergroup anal study didn't see a benefit for it, but it wasn't a terrible detriment either. I would consider chemotherapy for 2 cycles (FU/cisplatin l...