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Question re. Protocol

Marynb
Posts: 1134
Joined: Aug 2012

Does anyone know the accepted protocol for treatments and post treatment surveillance? I have particular concerns about follow up scNs. I have been told that the risk posed by radiation outweighed the need for a scan. I am just wondering what is the current practice, as people here have experienced it.

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mp327
Posts: 3017
Joined: Jan 2010

To get the latest update on protocol for treatment of anal cancer, please go to the website for the National Comprehensive Cancer Network (NCCN.org). You'll need to complete a registration, but then you'll have access to the latest protocol for treatment and follow-up. Scans are no longer recommended for follow-up, except in cases of T3-T4 tumors and/or evidence or residual or recurrent disease.

Marynb
Posts: 1134
Joined: Aug 2012

I went to that site, but I am a bit of a nut about privacy and I won't provide the information required for registration. Thanks for the information about scans.

mp327's picture
mp327
Posts: 3017
Joined: Jan 2010

I will give you the following info in a nutshell:

Localize Cancer:
5-FU & Mitomycin + Radiation Therapy
Continuous Infusion 5FU 1000 mg/m/d IV days 1-4 and 29-32
Mitomycin 10 mg/m IV bolus days 1 and 29
Concurrent radiotherapy

Metastatic Cancer:
5-FU + Cisplatin
Continuous infusion 5-FU 1000 mg/m/d IV days 1-5
Cisplatin 100 mg/m IV day 2
Repeat every 4 weeks

Principles of Radiation Therapy

All patients should receive a minimum dose of 45 GY in 25 fractions of 1.8 Gy over 5 weeks to the primary cancer with supervoltage radiation (photon energy of > mV) using multifield techniques.

PET-CT should be considered for treatment planning.

Initial radiation fields include the pelvis, anus, perineum, and inquinal nodes, with the superior field border at L5-S1 and the inferior border to include the anus with a minimum margin of 2.5 cm. around the anus and tumor. The lateral border of AP fields includes the lateral inguinal nodes as determined from bony landmarks or imaging. There should be attempts to reduce the dose to the femoral heads.

After a dose of 30.6 Gy in 17 fractions, the superior field extent is reduced to the bottom of the sacroiliac joints and an additional 14.4 Gy is given in 8 fractions (total dose of 45 Gy in 25 fractions/5 weeks), with additional field reduction off node-negative inguinal nodes after 36 Gy.

For patients treated with an AP-PA rather than 4-field technique, an anterior electron boost (matched to the PA exit field) is used to bring the lateral inguinal regions to the minimum dose of 36 Gy.

For patients with T3, T4, node-positive disease or patients with T2 residual disease after 45 Gy, the intent is usually to deliver an additional boost of 9 to 14 Gy in 1.8 to 2 Gy fractions (total dose of 54-59 Gy in 30-32 fractions over 6.0-7.5 weeks).

The target volume for boost field 2 is the original primary tumor volume-node plus a 2- to 2.5 cm. margin. Treatment field options include a multifield photon approach (AP-PA plus paired laterals, PA & lateral, or other) or a direct perineal boost with electrons or photons with the patient in lithotomy position.

Intensity modulated radiation therapy in addition to three dimensional conformal radiation therapy may be used in the treatment of patients with anal cancer.

Side effect management: Female patients should be considered for vaginal dilators and instructed on the symptoms of vaginal stenosis.

Follow-Up:

Evaluate in 8-12 weeks with exam & DRE.

For complete remission: Every 3-6 months for 5 years:
DRE
Anoscopy
Inguinal node palpation
T3-T4 or inguinal node positive--consider chest/abd/pelvic imaging annually for
3 years

I hope this gives you some additional information. I'm sorry you are uncomfortable registering on the NCCN website, as there is a lot more information given there that could be useful to you. I am not going to type in here the numerous pages of information contained in that particular protocol.

Marynb
Posts: 1134
Joined: Aug 2012

This is very helpful information. I wonder why they would require registration to obtain this kind of information. I am very reluctant to provide personal information .

mp327's picture
mp327
Posts: 3017
Joined: Jan 2010

I'm not sure of their reasons, but I think we should feel very fortunate that we, as patients, can get access to this information. If we could not, we would be at the complete mercy of irreputable sites and our doctors and, as we know, some of them are not very well versed when it comes to treating this disease. The only result I've experienced by registering on the NCCN website is getting their e-mails about upcoming meetings, etc., which isn't all bad.

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