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Anal IMRT

• Dose variation

• Elective dose 30/40Gy

• T1 40-45Gy

• T2 50-59

• T3/4 59-66Gy

• Significant G3/4 toxicity causes delays in RT

• Haem 61%, Derm 48%, GI 36%, GU 4%

• Published series showing reduced toxicity

Ajani JAMA 2008;299:1914