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Radiation therapy uses high-energy x-rays or particles to kill cancer cells. Depending on the stage of the anal cancer and other factors, radiation therapy might be used:
Different types of radiation therapy can be used to treat anal cancer. There are 2 main types:
External-beam radiation therapy (EBRT) focuses radiation from outside the body onto the cancer. This is the type of radiation therapy most often used to treat anal cancer or its spread to other organs.
Treatment is much like getting an x-ray, but the radiation dose is stronger. The procedure itself is painless and each treatment lasts only a few minutes. Most often, radiation treatments to the anal area are given 5 days a week for 5 to 7 weeks, but this can vary based on the type of EBRT and the reason it’s being given.
Newer techniques allow doctors to give higher doses of radiation to the cancer while reducing the radiation to nearby healthy tissues:
Three-dimensional conformal radiation therapy (3D-CRT) uses special computers to precisely map the location of the cancer. Radiation beams are then shaped and aimed at the tumor from several directions. This makes them less likely to damage normal tissues. You will most likely be fitted with a plastic mold like a body cast to keep you in the exact same position each time so that the radiation can be aimed more accurately.
Intensity-modulated radiation therapy (IMRT) is a form of 3D therapy and the preferred type of EBRT for anal cancer. It uses a computer-driven machine that rotates around you as it delivers radiation. Along with shaping the beams and aiming them from several angles, the intensity (strength) of the beams can be adjusted. This helps limit the dose reaching normal tissues and can reduce some side effects. IMRT lets doctors deliver a higher dose of radiation to the cancer compared to standard techniques.
Stereotactic body radiation therapy (SBRT) is a type of radiation that might be used if the anal cancer has come back in the same place or in the nearby lymph nodes. It might also be considered for tumors that have limited spread to other parts of the body, such as the brain.
Instead of giving a small dose of radiation each day for several weeks, SBRT uses very focused beams of high-dose radiation given in fewer (usually 1 to 5) treatments. Several beams are aimed at the tumor from different angles. For each treatment, you will lie in a specially designed body frame that keeps you still and in exactly the right place during treatment.
Side effects vary based on the part of the body treated and the dose of radiation given. Some common short-term side effects include:
In women, radiation may irritate the vagina. This can lead to discomfort and discharge.
Most of these side effects get better over time after radiation stops.
Long-term side effects can also occur:
Brachytherapy is not commonly used to treat anal cancer. When it is used, it's usually given as a radiation boost along with external radiation when a tumor isn't responding to regular chemoradiation (chemo plus external radiation).
Brachytherapy involves putting small sources of radioactive materials in or near the tumor. It focuses the radiation in the area of the cancer to minimize radiation damage to normal nearby tissue. Interstitial radiation or intracavitary radiation are different types of brachytherapy.
The possible side effects are a lot like those seen with external beam radiation therapy.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Arcadipane F, Franco P, Ceccarelli M, et al. Image-guided IMRT with simultaneous integrated boost as per RTOG 0529 for the treatment of anal cancer. Asia Pac J Clin Oncol. 2017 Aug 30.
Cordoba A, Escande A, Leroy T, et al. Low-dose-rate interstitial brachytherapy boost for the treatment of anal canal cancers. Brachytherapy. 2017;16(1):230-235.
Czito BG, Ahmed S, Kalady MF, and Eng C. Chapter 64: Cancer of the anal region. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkis; 2019.
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Heinze C, Omari J, Othmer M, Hass P, Seidensticker M, Damm R, et al. Image-guided Interstitial Brachytherapy in the Management of Metastasized Anal Squamous Cell Carcinoma. Anticancer Res. 2018;38(9):5401-5407.
Mitra D, Hong TS, Horick N, et al. Long-term outcomes and toxicities of a large cohort of anal cancer patients treated with dose-painted IMRT per RTOG 0529. Adv Radiat Oncol. 2017;2(2):110-117.
National Cancer Institute Physician Data Query (PDQ). Anal Cancer Treatment. 2020. Updated November 25, 2019. Accessed at https://www.cancer.gov/types/anal/patient/anal-treatment-pdq#_1 on March 16, 2020.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Anal Carcinoma. V.1.2020. Accessed at www.nccn.org/professionals/physician_gls/pdf/anal.pdf on March 16, 2020.
Shridhar R, Shibata D, Chan E, Thomas CR. Anal cancer: current standards in care and recent changes in practice. CA Cancer J Clin. 2015;65(2):139-162.
Last Revised: September 9, 2020
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