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The incidence of anal squamous cell carcinoma (ASCC) is rising [1]. The use of combination chemoradiotherapy as the primary treatment modality is well established and treatment regimens have changed little since the seminal work of Nigro et al. in the early 1970s [2]. Survival outcomes are favourable with contemporaneous 5-year overall survival (OS) of 65%-70% reported in North America and Europe [3,4]. Approximately 10%-15% of patients with ASCC present with T1 tumours for whom local excision (LE) alone

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