Clinical Practice Guideline: Anal Cancer—Diagnosis, Treatment and Follow-up

Background The rate of anal cancer has been rising steadily in recent times, so that the incidence is now double what it was 20 years ago. Almost all anal cancers are induced by persistent infection with human papillomaviruses. Hitherto the care of patients with anal cancer has been extremely heterogeneous; little experience has been gathered in the primary care sector. Methods In accordance with the stipulations of the German Guideline Program in Oncology on the methods to be followed in systematic research and consensus finding, interdisciplinary working groups were set up to compile suggestions for recommendations regarding the key questions. A systematic literature search was followed by endpoint-related assessment of the evidence in the context of the GRADE process. Results Ninety-three recommendations and statements were formulated. With regard to the recommendations for the treatment of early stages (stage I), there was no high-quality evidence permitting formulation of an evidence-based recommendation for or against local excision alone as an alternative to chemoradiotherapy. Chemoradiotherapy is the gold standard in the treatment of stages II-III. In the context of the recommendations on timing and extent of response evaluation after chemoradiotherapy, among other things there was consensus that no biopsy should ensue in the event of complete clinical response. Owing to lack of faith in the available evidence, only an open recommendation was pronounced for treatment in stage IV. Conclusion The clinical practice guideline provides a sound basis for optimization of interdisciplinary, cross-sector care. The research to date is deficient in, among other areas, the care of patients with early-stage or metastatic tumors. Promising approaches such as regional deep hyperthermia in combination with chemoradiotherapy need to be researched further. The part that can be played by novel forms of immunotherapy in the management of metastasized anal cancer has also been insufficiently explored to date.