Treatment results and follow-up after definitive radio-chemotherapy in anal cancer: when to perform biopsies?
Management of anal cancer shifted from radical surgical procedures to sphincter-preserving approaches by combined radio-chemotherapy (RCT). Several randomized trials investigated the most appropriate chemotherapy schedule, radiation doses, and treatment techniques. RCT employing 5-fluorouracil (5-FU)/mitomycin C (MMC) remains the standard treatment. Cisplatin was proposed as an alternative drug but failed to improve outcome when given instead of MMC or during maintenance chemotherapy. Currently, studies are ongoing that investigate staging procedures like PET-CT and diagnostic workup processes in treatment follow-up. This review focuses on treatment results of definitive RCT and factors related to treatment failure. Subsequent follow-up recommendations and the timing of invasive follow-up biopsies are discussed.