In the treatment of anal squamous cell carcinoma, the Nigro protocol (chemoradiotherapy with mitomycin C and 5-fluorouracil) is now the standard of care. Which of the following represents the original Nigro protocol dose of radiation?
- A 30 Gy in 15 fractions concurrent with 5-FU and MMC
- B 45–50 Gy with concurrent 5-FU and MMC as definitive treatment ✓
- C 45 Gy in 25 fractions with capecitabine alone
- D 54 Gy with concurrent oxaliplatin and capecitabine
Correct answer: B. 45–50 Gy with concurrent 5-FU and MMC as definitive treatment
Explanation
The original Nigro protocol used 30 Gy as a preoperative regimen, but the modern definitive standard (based on ACT I and RTOG 87-04 trials) uses 45–54 Gy concurrent with 5-FU (days 1–4, 29–32) and mitomycin C (day 1, day 29 in some protocols) to achieve cure without abdominoperineal resection. The ACT I trial established CRT over radiotherapy alone, showing improved locoregional control and colostomy-free survival. Surgery is reserved for biopsy-confirmed residual or recurrent disease at 12–16 weeks.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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