Anal squamous cell carcinoma (SCC) is treated with the Nigro protocol. What is the standard chemoradiation regimen in this protocol?

• A Radiotherapy 45 Gy + concurrent cisplatin + 5-FU
• B Radiotherapy 60 Gy + concurrent capecitabine + oxaliplatin
• C Abdominoperineal resection followed by adjuvant chemoradiotherapy
• D Radiotherapy 45–54 Gy + concurrent 5-FU + mitomycin C ✓

Explanation

The Nigro protocol (now the ACT I/ACT II validated standard) for anal canal SCC consists of external beam radiotherapy (45–54 Gy) with concurrent 5-fluorouracil (continuous infusion during weeks 1 and 5) and mitomycin C (bolus on day 1 and day 29). This achieves complete response rates of ~80% and avoids abdominoperineal resection (APR) in the majority. Cisplatin was compared to mitomycin C in ACT II and did not improve outcomes; mitomycin C remains standard. APR is reserved for salvage after chemoradiation failure.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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