Structured Abstract

Contents

• Preface
• Acknowledgments
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Executive Summary
  • Main Points
  • Background and Purpose
  • Methods
  • Results
  • Strengths and Limitations
  • Implications and Conclusions
• 1. Introduction
  • 1.1. Background
  • 1.2. Purpose of This Review
• 2. Methods
  • 2.1. Review Approach
  • 2.2. Study Selection
  • 2.3. Assessment of Risk of Bias
  • 2.4. Data Extraction and Data Management
  • 2.5. Data Synthesis
  • 2.6. Grading the Strength of the Body of Evidence
  • 2.7. Applicability Assessment
  • 2.8. Peer Review and Public Commentary
• 3. Results
  • 3.1. Overview
  • 3.2. Findings for Key Question 1: Initial Treatment Strategies
  • 3.3. Findings for Key Question 2: RT Modalities
  • 3.4. Findings for Key Question 3: RT Doses, Volumes, and Fractionation Schema
  • 3.5. Findings for Key Question 4: Dose De-Escalation and Escalation in CRT
  • 3.6. Findings for Key Question 5: Immunotherapy
  • 3.7. Findings for Key Question 6: Post-Treatment Surveillance
• 4. Discussion
  • 4.1. Overview
  • 4.2. Key Findings in Relation to Clinical Dilemmas
  • 4.3. Strengths and Limitations
  • 4.4. Implications for Clinical Practice and Policy
  • 4.5. Implications for Future Research
  • 4.6. Conclusions
• 5. References
• 6. Abbreviations and Acronyms
• Appendixes
  • Appendix A. Methods
  • Appendix B. References Excluded at Full-Text Screening
  • Appendix C. Evidence Tables
  • Appendix D. List of Unpublished Randomized Controlled Trials
  • Appendix E. PCORI Methodology Standards Checklist

Suggested citation:

Parikh RR, Troester A, Southwell B, Ester E, Sultan S, Claussen AM, Greeno E, Arsoniadis E, Church TR, Wilt TJ, Goffredo P, Butler M. Treatment of Stages I–III Squamous Cell Anal Cancer: A Systematic Review. Comparative Effectiveness Review No. 273. (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 75Q80120D00008.) AHRQ Publication No. 24-EHC026. PCORI^® Publication No. 2024-SR-03. Rockville, MD: Agency for Healthcare Research and Quality. August 2024. DOI: https://doi.org/10.23970/AHRQEPCCER273. Posted final reports are located on the Effective Health Care Program search page.

This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 75Q80120D00008). The Patient-Centered Outcomes Research Institute^® (PCORI^®) funded the report (PCORI^® Publication No. 2024-SR-03). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ or PCORI^®, its Board of Governors or Methodology Committee. Therefore, no statement in this report should be construed as an official position of PCORI^®, AHRQ, or of the U.S. Department of Health and Human Services.

Nonfinancial conflict of interest was reported by the investigators as follows: Dr. Paolo Goffredo and Dr. Elliot Arsoniadis are colorectal surgeons who treat patients with anal cancer, prescribe treatments examined in this report, and have published research related to anal cancer; Dr. Elizabeth Ester is a radiation oncologist who treats patients with anal cancer and prescribes treatments examined in this report; Dr. Edward Greeno is a medical oncologist who treats patients with anal cancer and prescribes treatments examined in this report; Dr. Bronwyn Southwell is an anesthesiologist; Dr. Shahnaz Sultan is a gastroenterologist. None of the investigators reported any financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. Most AHRQ documents are publicly available to use for noncommercial purposes (research, clinical or patient education, quality improvement projects) in the United States, and do not need specific permission to be reprinted and used unless they contain material that is copyrighted by others. Specific written permission is needed for commercial use (reprinting for sale, incorporation into software, incorporation into for-profit training courses) or for use outside of the United States. If organizational policies require permission to adapt or use these materials, AHRQ will provide such permission in writing.

PCORI^®, AHRQ, or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

A representative from AHRQ served as a Contracting Officer’s Representative and reviewed the contract deliverables for adherence to contract requirements and quality. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis, interpretation of data, or preparation or drafting of this report.

AHRQ and PCORI^® appreciate appropriate acknowledgment and citation of their work. Suggested language for acknowledgment: This work was based on an evidence report, Treatment of Stages I–III Squamous Cell Anal Cancer: A Systematic Review, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ) and funded by the Patient-Centered Outcomes Research Institute (PCORI^®).