What anal squamous cell carcinoma patients, if any, do you take to 59.4 Gy?

I will not usually treat a patient to over 54- 55.8 Gy.

The rate of sphincter dysfunction increases sharply at about this dose level and there is no compelling evidence that higher doses are of benefit.

However, for very extensive tumors, sphincter function may be severely compromised at presentation, and in those patients, there is only potential benefit in going to a higher dose- usually 59.4 Gy. Most of these patients will require an immediate diversion, prior to initiation of therapy, and the patient needs to understand that there will be a very low chance of having a takedown of the stoma and having a functional anus. There is little experience with higher doses, but stricture and bleeding are likely complications at higher doses and t...