Squamous cell carcinoma of the anal canal is primarily managed with which protocol, and what constitutes treatment failure at 26 weeks?
- A Nigro protocol (5-FU + mitomycin C + 45 Gy radiotherapy); biopsy-proven residual or progressive disease at 26 weeks post-treatment constitutes failure, mandating salvage APR ✓
- B Abdominoperineal resection (APR) as primary treatment; residual disease on imaging at 8 weeks is treatment failure
- C Nigro protocol; any residual mucosal irregularity at 12 weeks confirms failure requiring APR
- D Cisplatin + 5-FU + 45 Gy; CEA elevation at 26 weeks constitutes failure
Explanation
The Nigro protocol (concurrent 5-FU, mitomycin-C, and 45 Gy radiotherapy) achieves complete clinical response in 80-90% of anal SCC cases, making primary APR obsolete. Assessment at 26 weeks post-treatment allows adequate time for radiation-induced regression; premature biopsy may show false-positive residual disease from radiation changes. Biopsy-proven persistent or recurrent disease at 26 weeks (or progressive disease) mandates salvage APR. Cisplatin-based regimens are used for HIV-positive patients or clinical trials but are not the standard first-line replacement.
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.