Given the significant risk of recurrence after chemoradiation for locally advanced anal carcinoma, should resection be considered (with or without neoadjuvant treatment) in select cases?

At other sites we consider locally advanced disease and high risk of recurrence a contraindication for organ preservation. Would surgery improve likelihood of local control in locally advanced anal cancer?

From 98-11

T4N0 – 37 percent LRF

T3N+ – 44 percent LRF

T4N+ – 60 percent LRF

Answer from: Radiation Oncologist at Academic Institution

Interesting question. As a practical matter, many of the tumors that start out unresectable get replaced with dense fibrosis--and, therefore remain major surgical challenges even if there's residual cancer within the fibrosis. Many people argue that, since anal cancer can be slow to manifest ...

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Given the significant risk of recurrence after chemoradiation for locally advanced anal carcinoma, should resection be considered (with or without neoadjuvant treatment) in select cases?

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