Anal squamous cell carcinoma: what is the current first-line treatment per Nigro protocol and subsequent modifications?

• A Abdomino-perineal resection (APR) as definitive treatment
• B Cisplatin-based concurrent chemoradiation has replaced mitomycin-C as first-line
• C Radiation alone (54 Gy) is as effective as chemoradiation for T2 tumors
• D Concurrent chemoradiotherapy with mitomycin-C plus 5-FU (Nigro regimen); APR reserved for persistent/recurrent disease ✓

Explanation

The Nigro protocol — concurrent mitomycin-C (day 1) + 5-FU (days 1–4 and 29–32) with 45–54 Gy radiation — achieves complete response in 80–90% of anal SCC, rendering APR unnecessary as primary treatment. ACT I and ACT II trials confirmed mitomycin-C + 5-FU is superior to 5-FU alone and to cisplatin + 5-FU respectively, maintaining mitomycin-C + 5-FU as standard. APR is reserved for local treatment failure or persistent disease at 26-week reassessment. Radiation alone results in inferior locoregional control.

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.