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Gastrointest Cancer Res. 2014 Jan;7(1):4-14.

ACR Appropriateness Criteria®-Anal Cancer.

Author information

  • 1Massachusetts General Hospital, Boston, MA.
  • 2Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, MD.
  • 3Cleveland Clinic, Cleveland, OH.
  • 4Wake Forest University, Winston Salem, NC.
  • 5MD Anderson Cancer Center, Houston, TX.
  • 6Memorial Sloan-Kettering Cancer Center, New York, NY.
  • 7Cancer Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ.
  • 8University of Texas Health Science Center at San Antonio, San Antonio, TX.
  • 9Wayne State University School of Medicine, Detroit, MI.
  • 10Stanford University Medical Center, Stanford, CA.
  • 11The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL.
  • 12Knight Cancer Institute at Oregon Health and Science University, Portland, OR.
  • 13Indiana University School of Medicine, Indianapolis, IN.
  • 14Cancer Center of Santa Barbara, Santa Barbara, CA.


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.


Anal cancer; Chemoradiation; IMRT; Squamous cell carcinoma; chemotherapy

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