Clinical Condition: Anal Cancer

Variant 3: 73-year-old patient, T1N0M0. KPS 80.

Treatment	Rating	Comments
Local Excision, Negative Margins
RT + 5-FU + MMC	9	For CDDP, see text.
RT alone	4
APR	1
Brachytherapy alone	1
Local Excision, Positive Margins
RT + 5-FU + MMC	9	For CDDP, see text.
RT alone	4
Re-excision	1
APR	1
If RT + Chemotherapy: RT Dose to Primary
40 Gy/2.0 Gy	2
45 Gy/1.8 Gy	7
50.4 Gy/1.8 Gy	7
54 Gy/1.8 Gy	5
59.4 Gy/1.8 Gy	2
Technique: RT
IMRT	7
AP/PA photons	8
PA + laterals + electron boost to inguinal LNs	8
4-field box	3
If RT + Chemotherapy: RT Volume Needed
Pelvis + primary + medial inguinal LNs	8
Pelvis + primary + lateral inguinal LNs	4
Primary alone	1
Routine Post-treatment Biopsy
If progressive disease observed	9
If clinical regression observed	1
If stable disease observed	1
Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate