title: ACR Appropriateness Criteria®-Anal Cancer.
abstract: The management of anal cancer is driven by randomized and nonrandomized clinical trials. However, trials may present conflicting conclusions. Furthermore, different clinical situations may not be addressed in certain trials because of eligibility inclusion criteria. Although prospective studies point to the use of definitive 5-fluorouracil and mitomycin C-based chemoradiation as a standard, some areas remain that are not well defined. In particular, management of very early stage disease, radiation dose, and the use of intensity-modulated radiation therapy remain unaddressed by phase III studies. The American College of Radiology (ACR) Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Hong
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Pretz
authors.affiliation: Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: May
authors.initials: M
authors.lastname: Abdel-Wahab
authors.affiliation: Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD.
authors.forename: Nilofer
authors.initials: N
authors.lastname: Azad
authors.affiliation: Wake Forest University, Winston Salem, NC.
authors.forename: A William
authors.initials: AW
authors.lastname: Blackstock
authors.affiliation: MD Anderson Cancer Center, Houston, TX.
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
authors.affiliation: Cancer Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ.
authors.forename: Salma K
authors.initials: SK
authors.lastname: Jabbour
authors.affiliation: University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: William E
authors.initials: WE
authors.lastname: Jones
authors.affiliation: Wayne State University School of Medicine, Detroit, MI.
authors.forename: Andre A
authors.initials: AA
authors.lastname: Konski
authors.affiliation: Stanford University Medical Center, Stanford, CA.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Koong
authors.affiliation: MD Anderson Cancer Center, Houston, TX.
authors.forename: Miguel
authors.initials: M
authors.lastname: Rodriguez-Bigas
authors.affiliation: The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL.
authors.forename: William
authors.initials: W
authors.lastname: Small
authors.affiliation: Knight Cancer Institute at Oregon Health and Science University, Portland, OR.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Thomas
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zook
authors.affiliation: Cancer Center of Santa Barbara, Santa Barbara, CA.
authors.forename: W Warren
authors.initials: WW
authors.lastname: Suh
keywords: Anal cancer; Chemoradiation; IMRT; Squamous cell carcinoma; chemotherapy