Nigro protocol

Nigro protocol is the pre-operative use of chemotherapy with 5-fluorouracil and mitomycin and medical radiation for squamous cell carcinomas of the anal canal of less than 5 cm, followed by surgical excision if necessary. Specifically, in the protocol, the patient receives 30 Gy of radiation over a three-week period, as well as continuous administration of fluorouracil for the first four days and on days 29-32, with the mitomycin administered on the first day of treatment. It is named after Norman Nigro (1912–2009), who developed it in the mid-1970s. In cases of patients who still have residual disease after receiving the procotol, they should undergo salvage APR (abdomino-perineal resection). Response to treatment can be evaluated every 6-8 weeks for many months if disease is regressing or clinically stable. Any sign of progressive disease should prompt reassessment of disease with biopsy and subsequent surgery with the aforementioned APR.