Early stage anal margin cancer: towards evidence-based management.

Anal squamous cell carcinoma is an uncommon Human Papilloma Virus (HPV)‐related malignancy, the incidence of which has increased two‐ to four‐fold over the past three decades. Results from the first three phase III trials, performed in the 1990s (the largest being the ACT I trial in the UK), established concurrent mitomycin C (MMC), 5‐fluorouracil chemotherapy and radiotherapy (CRT) as the main primary treatment. Three subsequent trials (including ACT II in the UK, performed between 1998 and 2008, demonstrated evidence of no benefit from the use of additional chemotherapy before or after CRT, or concurrent cisplatin.