Anyone have any idea where the data on chemo for T2N0 Anal margin/perianal skin comes from? NCCN recommends concurrent chemoRT. Seems to me you could consider XRT alone with electrons for anal margin if anal margin is positive for invasive disease.
T2N0 Perianal Skin and NCCN
- Thread starter xrt123
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have one right now as well. If it is hpv+, I would treat as anal cancer. Probably could get away with electrons of a lower dose of chemo rads, but wouldnt risk it.
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Just had the exact same thing. Had to bite the bullet for chemo rt. Seems like total overkill; was prob neglected hence how it got to a T2 with proximity to the canal. Quick question; why would p16 solidify this? Aren’t many pure skins p16+ anyway?
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I don’t think skin is typically hpv+. Agree that you have to bite the bullet here. If pt fails, I can see some very judgemental docs lining up to be experts…
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By that you mean HPV PCR positive or p16+? Lots of skin cancers are HPV negative yet P16 positive. Would be tough call to treat a clear skin cancer as anal cancer but i see your point
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Do the chemo. Its a sensitive area and you are giving a lot of dose. If they fail after those doses wound healing can be a nightmare. I have had 2 of these cases come back to bite me. They can be deceptively aggressive.
HPV or not, if it is a true skin cancer (as in not involving the anal mucosa at all) I would also strongly consider using a cis-based regimen instead of MMC. Its worth reminding, the issue with the older cis trial in true anal cancers was the probably the use of induction in the cis arm and not the MMC arm. ACTII showed cis/FU was just as effective and had less hematologic toxicity. Still one of the more curious conclusions: the experimental arm was as effective, and less toxic, but since it required an extra infusion the control arm should remain SOC. If you are debating whether it is a skin primary or not, probably worth hedging and giving Cis
HPV or not, if it is a true skin cancer (as in not involving the anal mucosa at all) I would also strongly consider using a cis-based regimen instead of MMC. Its worth reminding, the issue with the older cis trial in true anal cancers was the probably the use of induction in the cis arm and not the MMC arm. ACTII showed cis/FU was just as effective and had less hematologic toxicity. Still one of the more curious conclusions: the experimental arm was as effective, and less toxic, but since it required an extra infusion the control arm should remain SOC. If you are debating whether it is a skin primary or not, probably worth hedging and giving Cis
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right thats exactly what i meant. have gotten into this boondoggle with H&N unknown primary hunts
