HJNO Nov/Dec 2022

HEALTHCARE JOURNAL OF NEW ORLEANS I  NOV / DEC 2022 55 Sukesh Manthri, MD Medical Oncologist Terrebonne General | Mary Bird Perkins Cancer Center second-line therapy, few data are available. Eligible patients should be encouraged to enroll in clinical trials testing new strategies. POST-TREATMENT SURVEILLANCE SCCs regress slowly and continue to de- crease in size for up to 26 weeks following therapy. We perform a clinical assessment of response by physical examination (digital rectal examination [DRE], palpation of the inguinal regions) from 8 to 12 weeks follow- ing the completion of therapy. n REFERENCES American Cancer Society. “Key Statistics for Anal Cancer.” Jan. 12, 2022. https://www.cancer.org/ cancer/anal-cancer/about/what-is-key-statistics. html National Comprehensive Cancer Network (NCCN). “NCCN Guidelines: Treatment by Cancer Type.” Accessed May 18, 2022. https://www.nccn . org/professionals/physician_gls Sukesh Manthri, MD, is a medical oncologist at Ter- rebonne General | Mary Bird Perkins Cancer Center, in Houma. He received a medical degree from the Prathima Institute of Medical Sciences in India. He completed a clinical research fellowship in Cleveland Clinic Florida followed by an internal medicine resi- dency at Southern Illinois University in Springfield. Subsequently, he completed a hospice and pallia- tive medicine fellowship at Saint Louis University in Missouri and was a medical oncology fellow at East Tennessee State University in Johnson City. In 2020, he received the Dr. Thomas G. Ronald Award for Ex- cellence in the Care of the Cancer Patient.He is board certified in oncology, internal medicine,hospice,and palliative medicine. anal sphincter in approximately 70 to 85%. The chemotherapy consists of infusional FU 1000mg/m2 on days 1 to 4 and 29 to 32 plus mitomycin 10 mg/m2 on days 1 and 29, a maximum of 20mg per dose. Most patients treated with chemoradiotherapy were cured (five-year overall survival of 67%) without an APR (five-year colostomy-free survival of 59%). Persistent or locally recurrent anal SCC following CRT can be successfully sal- vaged with surgery (typically APR). Local excision may be an option for care- fully selected patients with very favorable, small (<1 cm) superficially invasive tumors that are completely excised and have ≤3 mm of basement membrane invasion and a maximal horizontal spread of ≤7 mm. In the past, abdominoperineal resection (APR) was routinely performed for tumors arising in the anal canal. This radical procedure re- quired the removal of the anorectumand the creation of a permanent colostomy. Systemic therapy is the usual approach for treating metastatic anal squamous cell cancer. The liver is the most frequent site of distant metastases. For most patients with metastatic anal canal SCC, we recommend paclitaxel plus carboplatin. Immunotherapy monotherapy using agents that target the programmed cell death receptor 1 (PD-1) pathway is an option for patients who have progressed on first-line chemotherapy for metastatic SCC of the anus. Particularly for tomography (CT) of the chest, CT or mag- netic resonance imaging (MRI) of the abdo- men and pelvis, and an integrated positron emission tomography (PET)/CT scan. PRETREATMENT ASSESSMENT FOR HIV If HIV status is unknown, we recom- mend HIV testing for all individuals with newly diagnosed anal squamous cell cancer (SCC) or basal cell cancer. In general, HIV- positive patients are treated similarly to non-HIV-positive individuals. The pretreat- ment assessment for a patient with known HIV/AIDS should include a thorough his- tory, including infectious diseases and use of antiretroviral therapy (ART); review of HIV serology; a cluster of differentiation 4 (CD4) count and percentage; viral load; and screening for coinfections, including viral hepatitis. TREATMENT All carcinomas (squamous cell, adeno- carcinoma) that arise within any of the mucosal surfaces of the anal canal or the perianal skin are staged and treated similarly. Despite the absence of randomized trials directly comparing upfront chemoradio- therapy versus surgery, chemoradiothera- py has emerged as the preferred treatment method for anal canal SCC because it can cure many patients while preserving the