In a patient with newly diagnosed anal squamous cell carcinoma, who has an extensive history of active autoimmune disease including Crohn's, Lupus, and arthropathies on multiple therapies, would you forgo radiation therapy and proceed to APR upfront?

I've treated patients like this with standard chemoradiation, and while the GI toxicities are certainly increased, we have gotten them through curative treatment with aggressive symptom management. I would carefully counsel patients on APR vs increased risks of chemoradiation in the autoimmune context, and that APR may be needed should long-term bowel toxicities become a problem. The patient can make an informed decision between the two treatment options. A reasonable option, if it is an early s...