How would you treat a oligometastatic para-aortic recurrence 1 year after definitive chemo-radiation for anal cancer?

The recurrence is several adjacent nodes above the prior fields.

1 Answer

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Radiation Oncology · University of Texas MD Anderson Cancer Center

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We have successfully treated several patients with either synchronous or metachronous paraaortic nodal mets from anal SCCA with definitive dose chemoradiation. If not in a previously irradiated field- we give 50-58Gy in 25-29 fractions with concurrent cis and 5FU depending on the size of the node and proximity to luminal bowel structures. We also treat a CTV to 45-47Gy that encompasses the PA chain approx 1.5-2cm above and below the gross disease (or matching with the prior pelvic field if it is close).

For synchronous mets at least- we published a combined series with Mayo (Extended-Field Chemoradiation Therapy for Definitive Treatment of Anal Canal Squamous Cell Carcinoma Involving the Para-Aortic Lymph Nodes) which showed a success rate of ~50%. The predominant pattern of failure was distant mets (supraclav, liver, etc).