In our last episode, we laid the foundation for anal cancer management, establishing definitive concurrent chemoradiation as the sphincter-sparing standard of care, thanks to the pioneering work of Dr. Nigro and the pivotal ACT I and EORTC trials. We know why we use chemoradiation. Today, we focus on how to optimize it.Modern chemoradiation for anal cancer is a finely tuned balance of three critical components: the right chemotherapy, the right radiation dose, and the right timing. Getting any of these wrong can compromise cure rates or lead to unnecessary toxicity. Today, we’ll dissect the evidence for each of these pillars. We'll compare the key chemotherapy agents, Mitomycin C versus Cisplatin. We’ll justify modern, risk-adapted radiation dose escalation. And we will stress the crucial importance of completing treatment on schedule, without breaks.

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