MiFu (mitomycin C and 5-fluorouracil) was standard chemotherapy treatment until 2000. Cisplatin had shown a certain effect on recurrence and metastasizing anal cancer. Because of this and existing phase I and phase II studies, cisplatin combined with 5-FU neoadjuvant and adjuvant was introduced as primary treatment to improve survival times.
However on the basis of international randomized studies and international practice, which showed no better effect for CiFu, one chose to go back to MiFu. MiFu has less side effects and is easier to manage. In advanced stages (T3-4 and all N +) the treatment increased from one to two cycles concomitant.
Well to moderately differentiated T1 tumors < 1 cm N0
Chemotherapy is not standard.
Poorly differentiated T1 tumors, T1 > 1 cm and T2 tumors N0
A MiFu cycle concomitantly with radiation therapy starting the first or second day of radiation is recommended.
Advanced primary tumors (T3-T4, N0 and all N+)
Two MiFu cycles concomitantly with radiation therapy. The first cycle starts day 1 and second cycle on day 29 (5th radiation week).
Limited metastatic desease to lungs and liver
Limited metastatic desease to lungs and liver should be considered for curative surgery combined with preoperative chemotherapy. Two cycles of MiFu or two cycles of CiFu are given depending on previous chemotherapy given as primary treatment and response.
Metastatic desease which is not suitable for primary surgery should be considered for cisplatin/5-FU or possibly other types of chemotherapy. Subsequent surgery or radiation therapy should be considered if the response to chemotherapy is good.