Which of the following is correct about the Nigro regimen for “epidermoid” carcinoma of anal canal?
|A||External beam radiotherapy and chemotherapy as a substitute for surgery|
|B||Brachytherapy and chemotherapy|
|C||Chemotherapy and surgery|
|D||External beam radiotherapy and chemotherapy with surgery|
(REF. SABISTON SURGERY 18TH EDITION PG 1673, CHP 51)
a. The current Nigro protocol includes external-beam radiation therapy to the pelvic tumor and pelvic and inguinal nodes, to a total dose of 3000 cGy starting on day 1 using 15 fractions (200 cGy/day).Systemic chemotherapy includes 5-fluorouracil (5-FU), 1000 mg/m2 for 24 hours as continuous infusion for 4 days, commencing on day 1 and again on day 28 (two cycles total). Mitomycin C is delivered as an intravenous bolus at 15 mg/m2 starting on day 1 only.
b. In some patients APR may be considered more oppropaie Such groups would include patients who are already in need of a stoma for fecal incontinence, those for whom chemotherapy or radiation therapy is contraindicated, and those whose disease fails to resolve completely after radiation therapy plus chemotherapy.