Although these studies failed to reveal any superiority of alternative regimens to the Nigro protocol, important conclusions were derived. “HSiL,” “Nigro protocol,” “HPV,” “human papilloma. TABLE 1. The GRADE system-grading recommendationsa. Recommendation. Description. Benefit vs risk and. While modifications of Nigro and coworkers' protocol remain the standard of care today, the addition of mitomycin and the higher doses of radiotherapy do not.


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All 5 of these patients were treated during decade 3. During the course of the study, 4 nigro protocol modalities were used as the primary treatment of anal cancer: All 4 patients treated by surgery alone underwent abdominoperineal resection.

Epidermoid Cancers of the Anal Canal: Current Treatment

There were no local excisions. The "sequential nigro protocol protocol consisted of 1 cycle of intra-arterial chemotherapy doxorubicin hydrochloride or bleomycin sulfate followed by rad Gy of external beam radiation, a 6-week treatment break, then reexamination and abdominoperineal nigro protocol for persistent disease.

Over time there was a change in the primary treatment modality from sequential therapy to concurrent chemoradiation. Concurrent chemoradiation was administered in a fairly standard fashion.

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External beam radiation was delivered to the primary tumor site and inguinal areas for 5 to 6 weeks. Fluorouracil was infused during the first and last weeks of radiation, with most patients also receiving mitomycin with the first cycle of fluorouracil.

The mean dose of radiation increased from rad Figure 2 shows nigro protocol frequency nigro protocol which each modality was used.

These improved control rates include successful salvage therapy in 4 patients 1 sequential chemotherapy and radiation therapy in nigro protocol 1, 1 abdominoperineal resection in decade 2, and 2 abdominoperineal resections in decade 3 for locoregional failure.

Eight patients required palliative diverting colostomy for septic complications or incontinence, 4 at time of presentation and 4 during or after primary treatment.

Anal Cancer and Retrorectal Tumors: Epidermoid Cancers of the Anal Canal: Current Treatment

The 4 patients who underwent diversion at presentation had perianal sepsis and were discovered nigro protocol have advanced, perforated anal cancers 1 from decade 2 and 3 from decade 3.

In the cases of the other 4 patients, 1 underwent diversion for severe radiation proctitis midway through concurrent chemoradiation decade 21 underwent diversion nigro protocol perianal ulcers 4 months after radiation decade 31 had diversion for incontinence and unresectable tumor 4 months after radiation nigro protocol 1and 1 had diversion for perianal ulcers and incontinence 3 years after combined chemoradiation decade 2.

From a review of the patients' medical records, it was not possible to determine whether the exact cause of the incontinence in these patients was loss of rectal compliance, sphincter injury from radiation or direct tumor extension, or change in stool consistency.

Eight patients underwent abdominoperineal resection as part of their primary treatment, 1 of whom had previous palliative colostomy. Five patients underwent abdominoperineal resection for salvage, 1 of whom had previous palliative colostomy.

Carcinoma of the Anus: Strategies in Management

Complications of therapy were common Table 2. The number of minor complications was higher during nigro protocol third decade of the study.


The most common complications were dermatitis, diarrhea, and stomatitis. The number of major complications requiring additional surgery, grade III or IV toxicity, 9 or death remained constant nigro protocol the study Table 2.

Four patients died of treatment-related complications, 1 in each of the first and third decades and 2 in the second. Comment The last 30 years of the 20th century saw a major nigro protocol in the treatment nigro protocol anal canal carcinoma.

Carcinoma of the Anus: Strategies in Management

These 3 decades represent 3 nigro protocol of this development. During decade 1, from throughmost centers were performing radical surgery nigro protocol abdominoperineal resection as the treatment of choice. At our institutions, surgery was usually preceded by sequential chemotherapy and radiation therapy in an effort to reduce the high local recurrence rate.


Midway through this decade, Nigro protocol and colleagues 4 first reported their nigro protocol in sterilizing the tumor bed with preoperative concurrent fluorouracil, mitomycin initially porfiromycinand low-dose radiation therapy.

Spawned by impressive data from larger case series detailing improved survival, lower local recurrence rates, nigro protocol the reduction in the number of permanent colostomies, the "Nigro protocol" became the standard of care despite the absence of controlled trials.

Decade 2, throughrepresents this transitional phase in which concurrent chemoradiation began to replace other forms of therapy for anal canal cancer.