Anal cancer: are we making progress?

Anal cancer is an uncommon malignancy. There have been some intriguing developments in the past 3 years, in terms of our understanding of the molecular biology and processes that lead to anal cancer. There have also been some notable successes in prevention, imaging and treatment. Nonsurgical treatment is highly effective. The primary aim of such treatment is to achieve loco-regional control with chemoradiation (CRT), and preserve anal function without a colostomy. Randomised phase III trials presented or published over the past 3 years have explored novel strategies of neoadjuvant chemotherapy, maintenance chemotherapy, radiotherapy dose escalation and replacement of mitomycln C (MMC) with cisplatin in CRT. All have failed to improve on the current standard of care; i.e. MMC/ 5 fluorouracil (5FU) chemoradiation. However, more conformal strategies such as intensity modulated radiotherapy (IMRT) appear feasible to deliver with reduced toxicity, and may offer an opportunity to dose-escalate both to gross tumour and areas of potential nodal spread. Preliminary outcome data suggest no loss of efficacy. We evaluate the relevant recent literature published over the past 2 years, and summarize interesting and important new findings, with the aim of bringing the reader up-to-date on anal cancer.