Session Item

Personalised therapy is a key objective for patients with anal cancer. We have benefited from the implementation of intensity modulated radiotherapy (IMRT), or volumetric arc therapy (VMAT), and image-guided radiotherapy (IGRT), which can deliver high doses to tumour while sparing organs at risk and thereby reducing toxicity. These now offer the possibility of  investigating tailored approaches to determine the most suitable regimen in terms of radiotherapy dose prescription, target volume selection, normal tissue avoidance, and combination therapy. Radiobiological modelling of dose response and combination with classical clinicopathological parameters (T and N) has been used to propose dose escalation/de-escalation (these are tested in the ongoing PLATO trial ISRCTN 88455282). We will discuss the next steps in refining the treatment paradigms such as incorporating functional imaging to better refine biology and tumour targets and the use artificial intelligence to support selection and planning of treatment, predicting toxicity and cancer related outcomes.