Lymph Node Positivity in Patients with ANal Cancer treated in the Modern Era: prognostic impact and patterns of locoregional relapse (L‐NuANCE)
This project is the first to study a clinical dilemma in the treatment of anal cancer (AC). There are 1,200 new AC cases each year in the UK and numbers are growing. Initial treatment is chemo‐radiotherapy (CRT) with radiotherapy (RT). Local relapse occurs in 15-20% of cases; these require major specialist surgery. Overall, complications from treatment are common. If cancer spreads in AC, it is to lymph glands, and is known as positive lymph node (LN+). Historically, LN+ is associated with a bad outcome. New radiotherapy techniques, which focus radiation on the tumour and LN+, but are more intensive, are soon to be tested in a national trial. At the same time, new imaging techniques, such as MR and PET‐CT scans, have substantially increased the detection of LN+. The dilemma is that the new imaging methods may over‐diagnose LN+ and therefore lead to unnecessary treatment, while the new more focused radiotherapy may be too targeted and miss early undetected LN+.