Would you consider upfront chemoradiation therapy for a patient with metastatic anal squamous cell carcinoma if they have a large burden of disease at the anus?

There aren't many good systemic options for metastatic squamous cell carcinoma of the anus. In cases of significant local symptoms, I plan a definitive treatment using definitive dose with 5FU and cisplatin (mitomycin C may also be acceptable). This way, I have the option of giving full dose but the...

I think it all depends on the volume metastatic disease. In small volumes with a potential resection or SBRT, then upfront chemoradiation to attain good local control of the disease for quality of life measures is helpful. Then address the metastatic disease. If there is wide spread mets, I would gi...