Objective Despite excellent long-term outcomes, definitive chemoradiation (CRT) for squamous cell carcinoma (SqCC) of the anal canal with traditional radiotherapy techniques results in significant morbidity. Accruing data supports intensity-modulated radiotherapy (IMRT)-based treatment, and we report our institutional experience using this approach. Methods We reviewed patients with nonmetastatic anal canal SqCC treated with definitive IMRT-CRT. Clinically node-negative patients initially received 36 Gy to the elective pelvic and inguinal lymph nodes and 40 Gy to gross tumor volume (GTV) while node-positive patients received 45 and 50 Gy, respectively. All patients were considered for a GTV boost depending on the degree of clinical response and acute treatment-related toxicity.Results We identified 52 patients with T1-4N0-3M0 SqCC of the anal canal. Median follow-up was 21 months (range, 7.7-68.1 months). Two-year locoregional control, overall survival, disease-free survival, distant metastasis-free survival, and colostomy-free survival were 94.6, 100, 82.6, 90, and 94.7 %, respectively. Acute grade 3+ nonhematologic and hematologic toxicities were observed in 21.1 and 63.5 %, respectively. No acute grade 4 nonhematologic toxicity was observed. Conclusion Our series demonstrates that definitive IMRTbased chemoradiation with standard fractionation for anal SqCC results in excellent outcomes with minimal toxicity.

Permanent radioactive seed implantation provides highly effective treatment for prostate cancer that typically includes multidisciplinary collaboration between urologists and radiation oncologists. Low dose-rate (LDR) prostate brachytherapy offers excellent tumor control rates and has equivalent rates of rectal toxicity when compared with external beam radiotherapy. Owing to its proximity to the anterior rectal wall, a small portion of the rectum is often exposed to high doses of ionizing radiation from this procedure. Although rare, some patients develop transfusion-dependent rectal bleeding, ulcers or fistulas. These complications occasionally require permanent colostomy and thus can significantly impact a patient's quality of life. Aside from proper technique, a promising strategy has emerged that can help avoid these complications. By injecting biodegradable materials behind Denonviller's fascia, brachytherpists can increase the distance between the rectum and the radioactive sources to significantly decrease the rectal dose. This review summarizes the progress in this area and its applicability for use in combination with permanent LDR brachytherapy.

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