Chemoradiation Strategies in Anal Cancer Therapy

Anal squamous cell carcinoma is a rare malignancy whose incidence is rising globally, particularly among immunocompromised individuals and those with human papillomavirus infection. Organ preservation through chemoradiotherapy has become the standard of care, combining cytotoxic agents with external beam radiotherapy to achieve high rates of local control while sparing sphincter function. Standard regimens historically pair 5-fluorouracil and mitomycin C with conformal radiotherapy, though cisplatin‐based alternatives have been explored. Advances in imaging and treatment delivery, notably intensity-modulated radiation therapy, have refined dose modulation and reduced toxicity to surrounding tissues. Attention is increasingly focused on biological markers of response and resistance, including HPV status, tumour suppressor gene alterations and immune microenvironment profiles. Optimising the timing of response assessment, integrating novel radiosensitisers and immunotherapeutics, and standardising outcome measures are pivotal for future trials. These strategies carry significant implications for patient quality of life, healthcare resource allocation and global treatment guidelines.

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Chemoradiation Strategies in Anal Cancer Therapy publication trend

The graph below shows the total number of articles in chemoradiation strategies in anal cancer therapy across all publications each year (not limited to Nature Index journals).

Technical terms

Chemoradiotherapy (CRT): Combined administration of chemotherapy alongside radiotherapy to enhance tumour cell kill and protect organ function.

Intensity-Modulated Radiation Therapy (IMRT): Advanced radiotherapy technique that delivers precise radiation doses conforming to tumour geometry while minimising exposure to healthy tissues.

Complete Clinical Response: Absence of detectable tumour by clinical examination and imaging following completion of therapy.

Human Papillomavirus (HPV): A group of viruses, some subtypes of which are causally linked to anal squamous cell carcinoma and influence treatment response.

Programmed Death-Ligand 1 (PD-L1): An immune-regulatory protein expressed on tumour or immune cells that can be targeted by checkpoint inhibitors to enhance anti-tumour immunity.

References

1. International consensus to define outcomes for trials of chemoradiotherapy for anal cancer (CORMAC-2): defining the outcomes from the CORMAC core outcome set. EClinicalMedicine (2024).
2. Inflammatory pathways confer resistance to chemoradiotherapy in anal squamous cell carcinoma. npj Precision Oncology (2024).
3. Patterns and Predictors of Relapse Following Radical Chemoradiation Therapy Delivered Using Intensity Modulated Radiation Therapy With a Simultaneous Integrated Boost in Anal Squamous Cell Carcinoma. International Journal of Radiation Oncology • Biology • Physics (2019).