A 45-year-old man presents with a 4 cm squamous cell carcinoma of the anal canal (T2 N0 M0). The primary treatment of choice and the rationale for avoiding abdominoperineal resection (APR) is based on which landmark trial?
- A MOSAIC trial — established FOLFOX as standard adjuvant chemotherapy
- B Nigro protocol (Wayne State trial) — chemoradiation with 5-FU and mitomycin-C achieves equivalent survival to APR with preservation of the anal sphincter ✓
- C ACT II trial — showed cisplatin equivalent to mitomycin-C with maintenance chemotherapy
- D CAPOX trial — established capecitabine as substitute for infusional 5-FU
Explanation
The Nigro protocol (originally Wayne State University, 1974) established that concurrent chemoradiation with 5-fluorouracil and mitomycin-C (45 Gy over 5 weeks) achieves complete pathologic response in the majority of anal canal SCCs, rendering APR unnecessary in most cases. The ACT I and ACT II trials subsequently confirmed superior locoregional control with mitomycin-C over cisplatin. APR is now reserved for residual/recurrent disease after chemoradiation. The Nigro protocol fundamentally changed management from mandatory mutilating surgery to organ-preserving chemoradiation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.