What are special considerations in the treatment of anal cancer?

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See the list below:

Consider HIV testing and CD4 count analysis in patients with clinical risk factors.
No changes to therapy are indicated in HIV-infected patients; however, consider dose reduction of mitomycin in patients with low CD4 counts and a history of complications such as opportunistic infections or other malignancies.^[5]
Mitomycin + 5-FU: If nadir WBC count is less than 2400 but more than 1000/μL or if nadir platelet count is more than 50,000 but less than 85,000/μL, the second dose of mitomycin is reduced to 7.5 mg/m² from 10 mg/m²
If nadir WBC count is less than 1000 or if platelet count is less than 50,000/μL, the second dose of mitomycin is reduced to 5 mg/m² from 10 mg/m²
If on day 28 the WBC count is less than 2400/μL or if the platelet count is less than 85,000/μL, delay chemotherapy 1wk^[3]

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