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The recommended treatment for patients with localized anal cancer is radiation therapy in relatively high doses delivered over several weeks with concurrent chemotherapy. However, when anal cancer occurs in patients with high age, or with significant comorbidities, or who are frail, treatment often needs to be modified.

Some elderly patients are fit and are often recommended standard treatment. Others may have significant comorbidities or they may be frail. A geriatric assessment may be a useful tool for identifying frailty, and evaluating cognitive function, nutritional status, and functional impairment. This may guide treatment decisions for a modified treatment strategy or indicate supportive interventions that will increase the likelihood of completing an appropriate treatment plan.

For elderly and frail patients that can not tolerate standard of care, treatment must be modified. Alternative treatment strategies are often not described in guidelines, as there is little evidence base in the literature. Clinicians often select modified treatment strategies on an individual basis and according to institutional practice. Different treatment strategies including modifications to radiotherapy and chemotherapy regimens will be discussed.