Nigro protocol

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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.[1][2] 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.[3] It is named after Norman Nigro, who developed it in the mid-1970s.[4] 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 aforementionned APR.[5]


  1. ^ Al Hallak, M.Najeeb; George Hage-Nassar; Anas Mouchli (2010). "Primary Submucosal Squamous Cell Carcinoma of the Rectum Diagnosed by Endoscopic Ultrasound: Case Report and Literature Review". Case Reports in Gastroenterology 4 (2): 243–249. doi:10.1159/000319013. ISSN 1662-0631. 
  2. ^ Nigro ND, Vaitkevicius VK, Buroker T, Bradley GT, Considine B (1981). "Combined therapy for cancer of the anal canal". Dis. Colon Rectum 24 (2): 73–5. doi:10.1007/bf02604287. PMID 7215078. 
  3. ^ Ehrenpreis, Eli (2003). Anal and Rectal Diseases Explained. Remedica. p. 113. 
  4. ^ Blumetti, Jennifer; Bastawrous, Amir (27 May 2009). "Epidermoid Cancers of the Anal Canal: Current Treatment". Clinics in Colon and Rectal Surgery 22 (02): 077–083. doi:10.1055/s-0029-1223838. 
  5. ^ Nirula, Raminder (2006). High-yield Surgery. Lippincott Williams & Wilkins. p. 64.