Concurrent chemoradiation for localized cancer

5-FU + Mitomycin + RT regimen 1
5-FU 1000 mg/m2/d civi d1-4 and 29-32
Mitomycin 10 mg/m2 iv bolus d1 and 29
Concurrent radiotherapy 1.8 Gy/d x 5/w for 5 weeks to 45 Gy
4-6 weeks later, perform full thickness biopsy. If biopsy positive for residual tumor, start salvage treatment:
5-FU 1000 mg/m2/d civi d1-4
Cisplatin (CDDP) 100 mg/m2 iv over 4-6 hrs d2
Concurrent radiotherapy 1.8 Gy/d x 5 to 9 Gy
6 weeks later, perform another full thickness biopsy. If still positive, do abdominoperineal resection

Ajani JA et al. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal. JAMA 2008; 299:1914 (link to the article). 

Flam, M et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 1996; 14:2527
(link to the article).

5-FU + Mitomycin + RT regimen 2
5-FU 200 mg/m2/d civi d1-26
Mitomycin 10 mg/m2 iv d1
Concurrent radiotherapy to 36 Gy over 4 wks
2 wks later
5-FU 200 mg/m2/d civi d1-17
Mitomycin 10 mg/m2 iv d1
Concurrent radiotherapy to 23.4 Gy over 17 days

Bosset, JF et al. Shortened irradiation scheme, continuous infusion of 5-fluorouracil and fractionation of mitomycin C in locally advanced anal carcinomas. Results of a phase II study of the European Organization for Research and Treatment of Cancer. Radiotherapy and Gastrointestinal Cooperative Groups. Eur J Cancer 2003; 39:45 (link to the article).

Chemotherapy for metastatic cancer (back to top)

5-FU + Cisplatin
5-FU 1000 mg/m2/d civi d1-5
Cisplatin (CDDP) 100 mg/m2 iv d2
Q4w

Faivre, C et al. 5-fluorouracile and cisplatin combination chemotherapy for metastatic squamous-cell anal cancer. Bull Cancer 1999; 86:861 (link to the article).