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Radiation Therapy in Anal Cancer

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Radiation Oncology

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Abstract

The present standard of care in terms of treatment for squamous cell carcinoma of the anus is 5-Fluorouracil (5FU) and Mitomycin C (MMC) concurrently with radiation, which results in a high level of disease control for small early cancers. More advanced cancers still fare poorly with this treatment, and 30–50% of patients relapse locoregionally.

The anal sphincter is usually preserved with chemoradiation, although there are substantial acute and late effects and anorectal function is often compromised. The quantification of late toxicity and the role of stratifying radiotherapy dose according to biology, immune status, or other factors, as a potential for reducing toxicity, is discussed. Potential stratification factors include the human papilloma virus (HPV)-status (either defined by direct measurement or the surrogate of P16) as HPV-negative tumors appear to be less responsive to chemoradiation (CRT) and relapse more frequently. In contrast, HPV-positive tumors usually fare better and could potentially have equally high outcomes with lower doses. The presence of tumor-infiltrating lymphocytes (TIL), cigarette smoking, and immune competence all influence outcomes in SCCA and could be targets for stratification.

Radiotherapy dose stratification is possible due to modern radiotherapy techniques including intensity modulated radiotherapy with a simultaneous integrated boost. In routine delivery, these techniques are able to shorten overall treatment time without gaps in treatment, and reduce toxicity, avoiding treatment interruptions and improving compliance when compared to previous conformal treatments. The increasing use of novel immunological treatments (checkpoint inhibitors and vaccines) in HPV-positive cancers offers hope for the future.

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References

  • Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson AB 3rd, Thomas CR Jr, Mayer RJ, Haddock MG, Rich TA, Willett C. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA. 2008;299(16):1914–21.

    Article  CAS  PubMed  Google Scholar 

  • Ajani JA, Winter KA, Gunderson LL, et al. Prognostic factors derived from a prospective database dictate clinical biology of anal cancer: the intergroup trial (RTOG 98-11). Cancer. 2010;116(17):4007–13.

    Article  PubMed  Google Scholar 

  • Al-Jurf AS, Turnbull RP, Fazio VW. Local treatment of squamous cell carcinoma of the anus. Surg Gynecol Obstet. 1979;148(4):576–8.

    CAS  PubMed  Google Scholar 

  • Amini A, Jones BL, Ghosh D, Schefter TE, Goodman KA. Impact of facility volume on outcomes in patients with squamous cell carcinoma of the anal canal: analysis of the National Cancer Data Base. Cancer. 2017;123(2):228–36.

    Article  PubMed  Google Scholar 

  • Bartelink H, Roelofsen F, Eschwege F, Rougier P, Bosset JF, Gonzalez DG, Peiffert D, van Glabbeke M, Pierart M. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol. 1997;15(5):2040–9.

    Article  CAS  PubMed  Google Scholar 

  • Bentzen AG, Guren MG, Vonen B, Wanderås EH, Frykholm G, Wilsgaard T, et al. Faecal incontinence after chemoradiotherapy in anal cancer survivors: long-term results of a national cohort. Radiother Oncol. 2013;108(1):55–60.

    Article  PubMed  Google Scholar 

  • Bilimoria KY, Bentrem DJ, Rock CE, et al. Outcomes and prognostic factors for squamous-cell carcinoma of the anal canal: analysis of patients from the National Cancer Data Base. Dis Colon Rectum. 2009;52(4):624–31.

    Article  PubMed  Google Scholar 

  • Briere TM, Crane CH, Beddar S, et al. Reproducibility and genital sparing with a vaginal dilator used for female anal cancer patients. Radiother Oncol. 2012;104(2):161–6.

    Article  PubMed  Google Scholar 

  • Charnley N, Choudhury A, Chesser P, Cooper RA, Sebag-Montefiore D. Effective treatment of anal cancer in the elderly with low-dose chemoradiotherapy. Br J Cancer. 2005;92(7):1221–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chuong MD, Freilich JM, Hoffe SE, Fulp W, Weber JM, Almhanna K, et al. Intensity-modulated radiation therapy vs. 3D conformal radiation therapy for squamous cell carcinoma of the anal canal. Gastrointest Cancer Res. 2013;6:39–45.

    PubMed  PubMed Central  Google Scholar 

  • Clark J, Cleator S, Goldin R, Lowdell C, Darzi A, Ziprin P. Treatment of primary rectal squamous cell carcinoma by primary chemoradiotherapy: should surgery still be considered a standard of care. Eur J Cancer. 2008;44:2340–3.

    Article  CAS  PubMed  Google Scholar 

  • Das P, Bhatia S, Eng C, et al. Predictors and patterns of recurrence after definitive chemoradiation for anal cancer. Int J Radiat Oncol Biol Phys. 2007;68(3):794–80.

    Article  PubMed  Google Scholar 

  • Dasgupta T, Rothenstein D, Chou JF, Zhang Z, Wright JL, Saltz LB, et al. Intensity-modulated radiotherapy vs. conventional radiotherapy in the treatment of anal squamous cell carcinoma: a propensity score analysis. Radiother Oncol. 2013;107(2):189–94.

    Article  PubMed  Google Scholar 

  • De Vuyst H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S. Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int J Cancer. 2009;124(7):1626–36.

    Article  PubMed  CAS  Google Scholar 

  • Durrant L, Robinson M, Hawkins MA, Van den Heuvel F, Muirhead R. Quantifying target-specific motion in anal cancer patients treated with intensity modulated radiotherapy (IMRT). Radiother Oncol. 2016;121(1):92–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ellis RE. The distribution of active bone marrow in the adult. Phys Med Biol. 1961;5:255–8.

    Article  CAS  PubMed  Google Scholar 

  • Flam M, John M, Pajak TF, Petrelli N, Myerson R, Doggett S, Quivey J, Rotman M, Kerman H, Coia L, Murray K. Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol. 1996;14(9):2527–39.

    Article  CAS  PubMed  Google Scholar 

  • Franco P, Arcadipane F, Ragona R, et al. Dose to specific subregions of pelvic bone marrow defined with FDG-PET as a predictor of hematologic nadirs during concomitant chemoradiation in anal cancer patients. Med Oncol. 2016;33(7):72.

    Article  PubMed  CAS  Google Scholar 

  • Franco P, Fiandra C, Arcadipane F, Trino E, Giglioli FR, Ragona R, Ricardi U. Incorporating 18FDG-PET-defined pelvic active bone marrow in the automatic treatment planning process of anal cancer patients undergoing chemo-radiation. BMC Cancer. 2017;17(1):710.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Fraunholz IB, Haberl A, Klauke S. Long-term effects of chemoradiotherapy for anal cancer in patients with HIV infection: oncological outcomes, immunological status, and the clinical course of the HIV disease. Dis Colon Rectum. 2014;57:423–31.

    Article  PubMed  Google Scholar 

  • Fuchshuber PR, Rodriguez-Bigas M, Weber T, Petrelli NJ. Anal canal and perianal epidermoid cancers. J Am Coll Surg. 1997;185(5):494–505.

    Article  CAS  PubMed  Google Scholar 

  • Gilbert DC, Serup-Hansen E, Linnemann D, et al. Tumour-infiltrating lymphocyte scores effectively stratify outcomes over and above p16 post chemo-radiotherapy in anal cancer. Br J Cancer. 2016;114(2):134–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Glynne-Jones R, Meadows H, Wan S, et al. EXTRA – a multicenter phase II study of chemoradiation using a 5 day per week oral regimen of capecitabine and intravenous mitomycin C in anal cancer. Int J Radiat Oncol Biol Phys. 2008;72(1):119–26.

    Article  CAS  PubMed  Google Scholar 

  • Glynne-Jones R, Sebag-Montefiore D, Adams R, for the UKCCCR Anal Cancer Trial Working Party, et al. ‘Mind the gap’–the impact of variations in the duration of the treatment gap and overall treatment time in the first UK Anal Cancer Trial (ACT I). Int J Radiat Oncol Biol Phys. 2011;81(5):1488–94.

    Article  PubMed  Google Scholar 

  • Glynne-Jones R, Nilsson PJ, Aschele C, Goh V, Peiffert D, Cervantes A, Arnold D. Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis treatment and follow up. Ann Oncol. 2014;25(Suppl 3):iii10–20.

    Article  PubMed  Google Scholar 

  • Glynne-Jones R, Meadows AH, Lopes A, et al. Compliance to chemoradiation (CRT) using mitomycin (MMC) or cisplatin (CisP), with or without maintenance 5FU/CisP chemotherapy (CT) in squamous cell carcinoma of the anus (SCCA) according to radiotherapy (RT) dose, overall treatment time (OTT) and chemotherapy (CT) and their impact on long-term outcome: results of ACT II. J Clin Oncol. 2015;33(Suppl; abstr 3518).

    Google Scholar 

  • Glynne-Jones R, Sebag-Montefiore D, Meadows HM, et al. ACT II study group. Best time to assess complete clinical response after chemoradiotherapy in squamous cell carcinoma of the anus (ACT II): a post-hoc analysis of randomised controlled phase 3 trial. Lancet Oncol. 2017;18(3):347–56.

    Article  PubMed  PubMed Central  Google Scholar 

  • Goh V, Gollub FK, Liaw J, et al. Magnetic resonance imaging assessment of squamous cell carcinoma of the anal canal before and after chemoradiation: an MRI predict for eventual clinical outcome? Int J Radiat Oncol Biol Phys. 2010;78(3):715–21.

    Article  PubMed  Google Scholar 

  • Grulich AE, van Leeuwen MT, Falster MO, et al. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007;370(9581):59–67.

    Article  PubMed  Google Scholar 

  • Guerra GR, Kong CH, Warrier SK, Lynch AC, Heriot AG, Ngan SY. Primary squamous cell carcinoma of the rectum: an update and implications for treatment. World J Gastrointest Surg. 2016;8(3):252–65.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gunderson LL, Winter KA, Ajani JA, Pedersen JE, Moughan J, Benson AB 3rd, et al. Long-term update of U.S. GI intergroup RTOG 98-11 phase III trial for anal carcinoma: survival, relapse and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomycin versus fluoruracil/cisplatin. J Clin Oncol. 2012;30:4344–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gunderson LL, Moughan J, Ajani JA, et al. Anal carcinoma: impact of TN category of disease on survival, disease relapse, and colostomy failure in US Gastrointestinal Intergroup RTOG 98-11 phase 3 trial. Int J Radiat Oncol Biol Phys. 2013;87(4):638–45.

    Article  PubMed  PubMed Central  Google Scholar 

  • Herfs M, Longuespée R, Quick CM, et al. Proteomic signatures reveal a dualistic and clinically relevant classification of anal canal carcinoma. J Pathol. 2017;241(4):522–33.

    Article  CAS  PubMed  Google Scholar 

  • James RD, Glynne-Jones R, Meadows H, Cunningham D, Myint AS, Saunders MP, et al. Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2 × 2 factorial trial. Lancet Oncol. 2013;14:516–24.

    Article  CAS  PubMed  Google Scholar 

  • Jeong BG, Kim DY, Kim SY. Concurrent chemoradiotherapy for squamous cell carcinoma of the rectum. Hepatogastroenterology. 2013;60:512–6.

    CAS  PubMed  Google Scholar 

  • Joseph K, Vos LJ, Warkentin H, et al. Patient reported quality of life after helical IMRT based concurrent chemoradiation of locally advanced anal cancer. Radiother Oncol. 2016;120(2):228–33.

    Article  PubMed  Google Scholar 

  • Kachnic LA, Winter K, Myerson RJ, et al. RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys. 2013;86(1):27–33.

    Article  CAS  PubMed  Google Scholar 

  • Karia PS, Jambusaria-Pahlajani A, Harrington DP, Murphy GF, Qureshi AA, Schmults CD. Evaluation of American Joint Committee on Cancer, International Union Against Cancer, and Brigham and Women’s Hospital tumor staging for cutaneous squamous cell carcinoma. J Clin Oncol. 2014;32(4):327–34.

    Article  PubMed  Google Scholar 

  • Kochhar R, Renehan AG, Mullan D, Chakrabarty B, Saunders MP, Carrington BM. The assessment of local response using magnetic resonance imaging at 3- and 6-month post chemoradiotherapy in patients with anal cancer. Eur Radiol. 2017;27(2):607–17.

    Article  PubMed  Google Scholar 

  • Kulaylat AS, Hollenbeak CS, Stewart DB Sr. Squamous cancers of the rectum demonstrate poorer survival and increased need for salvage surgery compared with squamous cancers of the anus. Dis Colon Rectum. 2017;60(9):922–7.

    Article  PubMed  Google Scholar 

  • Leichman L, Nigro N, Vaitkevicius VK, et al. Cancer of the anal canal: model for preoperative adjuvant combined modality therapy. Am J Med. 1985;78(2):211–21.

    Article  CAS  PubMed  Google Scholar 

  • Lengelé B, Scalliet P. Anatomical bases for the radiological delineation of lymph node areas. Part III: pelvis and lower limbs. Radiother Oncol. 2009;92(1):22–33.

    Article  PubMed  Google Scholar 

  • Liang Y, Messe K, Rose BS, et al. Impact of bone marrow radiation dose on acute hematologic toxicity in cervical cancer: principal component analysis on high dimensional data. Int J Radiat Oncol Biol Phys. 2010;78:912–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mazeron JJ, van Limbergen E. Anorectal cancer. In: Gerbaulet A, Pötter R, Mazeron J, Meertens H, VanLimbergen E, editors. The GECESTROH and book of Brachy therapy. Brussels: ESTRO; 2000. p. 505–14.

    Google Scholar 

  • Mell LK, Schomas DA, Salama JK, et al. Association between bone marrow dosimetric parameters and acute hematologic toxicity in anal cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008;70:1431–7.

    Article  PubMed  Google Scholar 

  • Morris VK, Salem ME, Nimeiri H, et al. Nivolumab for previously treated unresectable metastatic anal cancer (NCI9673): a multicentre, single-arm, phase 2 study. Lancet Oncol. 2017;18(4):446–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Muirhead R, Adams RA, Gilbert DC, et al. Anal cancer: developing an intensity modulated radiotherapy solution for ACT2 fractionation. Clin Oncol (R Coll Radiol). 2014;26:720–1.

    Article  CAS  Google Scholar 

  • Muirhead R, Partridge M, Hawkins MA. A tumor control probability model for anal squamous cell carcinoma. Radiother Oncol. 2015;116(2):192–6.

    Article  PubMed  Google Scholar 

  • Muirhead R, Drinkwater K, O’Cathail SM, et al. Initial results from the Royal College of Radiologists’ UK National Audit of Anal Cancer Radiotherapy 2015. Clin Oncol (R Coll Radiol). 2017;29(3):188–97.

    Article  CAS  Google Scholar 

  • Musio D, De Felice F, Manfrida S, Balducci M, Meldolesi E, Gravina GL, Tombolini V, Valentini V. Squamous cell carcinoma of the rectum: the treatment paradigm. Eur J Surg Oncol. 2015;41:1054–8.

    Article  CAS  PubMed  Google Scholar 

  • Myerson RJ, Garofalo MC, El Naqa I, et al. Elective clinical target volumes for conformal therapy in anorectal cancer: a radiation therapy oncology group consensus panel contouring atlas. Int J Radiat Oncol Biol Phys. 2009;74(3):824–30.

    Article  PubMed  Google Scholar 

  • NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Anal carcinoma version 1.2020 – November 19,2019 NCCN.org. Last visited 26 April 2020.

    Google Scholar 

  • Ng M, Leong T, Chander S, et al. Australasian Gastrointestinal Trials Group (AGITG) contouring atlas and planning guidelines for intensity-modulated radiotherapy in anal cancer. Int J Radiat Oncol Biol Phys. 2012;83:1455–62.

    Article  PubMed  Google Scholar 

  • Nigro ND, Vaitkevicus VK, Considine B Jr. Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum. 1974;17:354–35.

    Article  CAS  PubMed  Google Scholar 

  • Nilsson PJ, Svensson C, Goldman S, et al. Epidermoid anal cancer: a review of a population-based series of 308 consecutive patients treated according to prospective protocols. Int J Radiat Oncol Biol Phys. 2005;61(1):92–102.

    Article  PubMed  Google Scholar 

  • Northover J, Meadows H, Ryan C, Gray R, on behalf of UKCCCR Anal Cancer Trial Working Party. Combined radiotherapy and chemotherapy for anal cancer. Lancet. 1997;349(9046):205–6.

    Article  Google Scholar 

  • Northover J, Glynne-Jones R, Sebag-Montefiore D, James R, Meadows H, Wan S, et al. Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I). Br J Cancer. 2010;102(7):1123–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Osborne EM, Eng C, Skibber JM, et al. Hyperfractionated accelerated reirradiation for patients with recurrent anal cancer previously treated with definitive chemoradiation. Am J Clin Oncol. 2016. [Epub ahead of print].

    Google Scholar 

  • Peiffert D, Tournier-Rangeard L, Gerald JP, Lemanski C, Francois E, Giovannini M, et al. Induction chemotherapy and dose intensification of the radiation boost in locally advanced anal canal carcinoma: final analysis of the randomized UNICANCER ACCORD 03 trial. J Clin Oncol. 2012;30:1941–4.

    Article  CAS  PubMed  Google Scholar 

  • Rasheed S, Yap T, Zia A, McDonald PJ, Glynne-Jones R. Chemo-radiotherapy: an alternative to surgery for squamous cell carcinoma of the rectum – report of six patients and literature review. Colorectal Dis. 2009;11:191–7.

    Article  CAS  PubMed  Google Scholar 

  • Rattan R, Kapoor R, Bahl A, Gupta R, Oinam AS, Kaur S. Comparison of bone marrow sparing intensity modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT) in carcinoma of anal canal: a prospective study. Ann Transl Med. 2016;4(4):70.

    PubMed  PubMed Central  Google Scholar 

  • Robinson M, Sabbagh A, Muirhead R, et al. Modeling early haematologic adverse events in conformal and intensity-modulated pelvic radiotherapy in anal cancer. Radiother Oncol. 2015;117(2):246–51.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rogers JE, Crane CH, Das P, et al. Definitive chemoradiation in oligometastatic squamous cell carcinoma of the anal canal. Gastrointest Cancer Res. 2014;7(2):65–8.

    PubMed  PubMed Central  Google Scholar 

  • Sebag-Montefiore D, James R, Meadows H. The pattern and timing of disease recurrence in squamous cancer of the anus: mature results from the NCRI ACT II trial. J Clin Oncol. 2012;30(Suppl; abstr 4029).

    Google Scholar 

  • Sekhar H, Zwahlen M, Trelle S, et al. Nodal stage migration and prognosis in anal cancer: a systematic review, meta-regression, and simulation study. Lancet Oncol. 2017. https://doi.org/10.1016/S1470-2045(17)30456-4. pii: S1470-2045(17)30456-4. [Epub ahead of print].

  • Serup-Hansen E, Linnemann D, Skovrider-Ruminski W, et al. Human papillomavirus genotyping and p16 expression as prognostic factors for patients with American Joint Committee on Cancer stages I to III carcinoma of the anal canal. J Clin Oncol. 2014;32:1812–7.

    Article  PubMed  Google Scholar 

  • Shepherd NA, Schofield JH, Love SB, et al. Prognostic factors in anal squamous carcinoma: a multi variant analysis of clinical, pathological and flow cytometric perimeters in 235 cases. Histopathology. 1990;16:545–55.

    Article  CAS  PubMed  Google Scholar 

  • Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30.

    Article  PubMed  Google Scholar 

  • Sodergren SC, Vassiliou V, Dennis K, Tomaszewski KA, Gilbert A, Glynne-Jones R, Nugent K, Sebag-Montefiore D, Johnson CD, EORTC Quality of Life Group. Systematic review of the quality of life issues associated with anal cancer and its treatment with radiochemotherapy. Support Care Cancer. 2015;23(12):3613–23.

    Article  PubMed  Google Scholar 

  • Souza KT, Pereira AA, Araujo RL, et al. Replacing 5-fluorouracil by capecitabine in localised squamous cell carcinoma of the anal canal: systematic review and meta-analysis. Ecancermedicalscience. 2016;10:699. https://doi.org/10.3332/ecancer.2016.699. eCollection 2016.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sparano JA, Lee JY, Palefsky J, et al. Cetuximab plus chemoradiotherapy for human immunodeficiency virus-associated anal carcinoma: a phase II AIDS Malignancy Consortium Trial (AMC045). J Clin Oncol. 2017;35(7):727–33.

    Article  CAS  PubMed  Google Scholar 

  • Tinger A, Michalski JM, Bosch WR, Valicenti RK, Low DA, Myerson RJ. An analysis of intratreatment and intertreatment displacements in pelvic radiotherapy using electronic portal imaging. Int J Radiat Oncol Biol Phys. 1996;34(3):683–90.

    Article  CAS  PubMed  Google Scholar 

  • Tseng HF, Morgenstern H, Mack TM, Peters RK. Risk factors for anal cancer: results of a population-based case – control study. Cancer Causes Control. 2003;14(9):837–46.

    Article  PubMed  Google Scholar 

  • UKCCCR Anal Cancer Working Party. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil and mitomycin. Lancet. 1996;348:1049–54.

    Article  Google Scholar 

  • Wright JL, Patil S, Temple L, et al. Squamous cell carcinoma of the anal canal: patterns and predictors of failure and implications for intensity modulated radiation treatment planning. Int J Radiat Oncol Biol Phys. 2009;78(4):1064–72.

    Article  Google Scholar 

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Conflict of Interest

Rob Glynne-Jones has received honoraria for lectures and advisory boards and has been supported in attending international meetings by Merck, Pfizer, Sanofi-Aventis, Eli-Lilley and Roche, Servier, Amgen, and Mundipharma. He has also received unrestricted grants for research from Merck-Serono, Sanofi-Aventis, and Roche.

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  1. Mount Vernon Centre for Cancer Treatment, Northwood, UK

    Rob Glynne-Jones

  2. Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    Rebecca Muirhead

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Correspondence to Rob Glynne-Jones .

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  1. Department of Radiation Oncology, University Hospital Mannheim, Mannheim, Germany

    Frederik Wenz

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Glynne-Jones, R., Muirhead, R. (2018). Radiation Therapy in Anal Cancer. In: Wenz, F. (eds) Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-52619-5_48-1

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