Would you include the tract in your treatment field in a patient with squamous cell carcinoma of the anal canal presenting with an ano-cutaneous fistula?

If so, would you add it to your high or low dose PTV? Notably, on PET/CT, the fistulous tract has PET tracer uptake with SUV max 5-6, and the PET avidity of the primary tumor has an SUV max 12.

Answer from: Radiation Oncologist at Community Practice

I don't know that there is an evidence-informed answer, but I just had this in a patient recently. We had him get a diverting colostomy prior to starting CRT, then treated him with standard CRT with 5FU/MMC. I included the fistula tract in an intermediate dose, but with a margin on the boost to tumo...

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Radiation Oncologist at Beth Israel Deaconess Medical Center
I would agree with this.

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Would you include the tract in your treatment field in a patient with squamous cell carcinoma of the anal canal presenting with an ano-cutaneous fistula?

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