Role of radiotherapy in the management of anal canal cancer: Recommendations of the Société française de radiothérapie oncologique.

We present the updated recommendations from the Société française de radiothérapie oncologique (SFRO, the French society for radiation oncology) regarding the use of external beam radiotherapy and brachytherapy in the management of anal cancer. Anal cancer is a rare malignancy with an increasing incidence, largely due to the high prevalence of Human papillomavirus infection. It primarily affects females over 65years of age. The most common histological type is squamous cell carcinoma. The standard treatment involves a combination of intensity-modulated radiotherapy and concurrent chemotherapy with 5-fluorouracil (or capecitabine) and mitomycin. A localized boost dose to the tumour can be delivered either by external beam radiotherapy or brachytherapy. Recent studies have demonstrated that intensity-modulated radiotherapy helps avoid treatment interruptions, which are considered detrimental to efficacy. However, while radiotherapy achieves good outcomes for T1-T2 tumours without nodal involvement, T3-T4 stages or tumours with nodal involvement are associated with a poorer prognosis. Therefore, concomitant chemotherapy (5-fluorouracil or capecitabine with mitomycin) is recommended for tumours greater than 3cm or those with nodal invasion. This approach remains a topic of debate for early-stage tumours. Target volumes, organs at risk delineation, doses, and fractionation regimens are discussed with respect to the balance between treatment efficacy and toxicity. Follow-up recommendations are provided to ensure early detection of cancer recurrence and late treatment-related side effects.