Anal squamous cell carcinoma affects approximately 1100 patients per year in the UK, with the incidence increasing yearly [1]. The ACT2 trial, delivering radical chemoradiotherapy, determined the UK standard of care; reporting a complete response rates of 90% and a 3 year progression-free survival of 73% [2]. Due to the large parallel-opposed anterior-posterior/posterior-anterior (AP/PA) fields, there was significant associated acute toxicity; grade 3/4 gastrointestinal and haematological toxicity of 16 and 26%, respectively. Acute toxicity results in delays and interruptions; a concern, as there is evidence to suggest overall treatment time is associated with local control [3-5]. Finally, there is a lack of prospective data quantifying the recognised late side-effects on bowel, urinary and sexual function. Late bowel toxicity culminating in colostomy was seen in 2% of patients in the ACT2 trial [6].
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