Abstract
Background: Anal squamous cell carcinoma (ASCC) is a rare tumor; it accounts for about 2% of gastrointestinal tumors. The goal of the treatment is to preserve the anal sphincter and maintain the quality of life; surgical excision is therefore reserved only for very early stages and in vast majority of cases concomitant chemoradiotherapy (CRT) is indicated, i.e. pelvic irradiation and concomitant mitomycin-based chemotherapy.
Technological development in the field of radiodia-gnostics, nuclear medicine and radiation therapy has improved the disease staging and enabled more gentle treatment. The standard regimen of chemotherapy has been based on the combination of mitomycin C (MMC) with 5-fluorouracil (5-FU) for many years, with high toxicity.
Purpose: The administration of 5-FU + capecitabine regimen provided an opportunity to reduce acute haematological toxicity. A prospective randomized phase II trial EXTRA demonstrated the oncological safety and good toxicity profile of oral capecitabine administered instead of 5-FU.
The reduction of severe haematological toxicity and oncological non-inferiority of the capecitabine regimen was also demonstrated by other nine analyses presented in this article. Conclusion: Most international guidelines published by societies such as the National Comprehensive Cancer Network, the European Society for Medical Oncology or the European Society for Therapeutic Radiology and Oncology have accepted capecitabine as a safe alternative to 5-FU in the treatment of ASCC and CRT regimen with oral capecitabine becoming the standard.
The advantages are: proven excellent treatment results (non-inferiority towards standard regimens), significant reduction of various types of toxicity and the convenience of outpatient oral capecitabine.