Discrepancies between NCCN and ESMO guidelines in the management of anal cancer: a qualitative review

Natalie Johnson, Gianluca Pellino, Constantinos Simillis, Shengyang Qiu, Stella Nikolaou, Daniel L. Baird, Shahnawaz Rasheed, Paris P. Tekkis, Christos Kontovounisios*

*Corresponding author for this work

Research output: Contribution to journalReview articleResearchpeer-review

7 Citations (Scopus)


There is an ever-growing need, with the ongoing developments in research and the progress towards patient centered care, to delineate standardized protocols of management of anal cancer. However, guidelines from different societies show some degree of disagreement. This is a systematic review of the literature to identify similarities and discrepancies between the guidelines for the management of anal cancer drafted by the European Society for Medical Oncology (ESMO) and by the National Comprehensive Cancer Network (NCCN). We found essentially similar management for investigation, diagnosis, chemotherapy regimens, and radiotherapy doses in both ESMO and NCCN recommendations in the management of anal cancer. There were few differences, which included the levels of evidence and grades of recommendations, the delineation of radiotherapy fields, and the treatment of the elderly and personalized medicine based on genetics. The follow-up regime is also marginally different in the first 2 years. Even if the observed differences may be justified by a different implementation of evidence-based medicine among different countries for particular management modalities of anal cancer, we identified the grey areas which need further study. In addition, these facets should be assessed more carefully when planning future guidelines.

Original languageEnglish
Pages (from-to)345-349
Number of pages5
JournalUpdates in Surgery
Issue number3
Publication statusPublished - 1 Sept 2017


  • Anal cancer
  • Discrepancies
  • European Society of Medical Oncology (ESMO)
  • National Comprehensive Cancer Network (NCCN)


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