Intensity-Modulated Radiation Therapy, Fluorouracil, and Mitomycin C in Treating Patients With Invasive Anal Cancer

You may be eligible if

• DISEASE CHARACTERISTICS:
• Histologically confirmed carcinoma of the anal canal, including any of the following subtypes:
• * Squamous cell
• * Basaloid
• * Cloacogenic
• Primary invasive disease
• T2-4, N0-3 disease
• * Clinically positive small inguinal nodes (i.e., \< 1 cm in size) must be confirmed by biopsy (preferably fine-needle aspiration) within the past 6 weeks
• * Biopsy is not required for enlarged inguinal, perirectal, or pelvic nodes on exam or CT scan that are found to be ≥ 1.0 cm and are considered to be clinically positive
• PATIENT CHARACTERISTICS:
• Zubrod performance status 0-1
• Hemoglobin ≥ 8.0 g/dL (transfusion or other intervention allowed)
• ALT and AST \< 3 times upper limit of normal
• Absolute neutrophil count ≥ 1,800/mm³
• Serum creatinine ≤ 1.5 mg/dL
• Platelet count ≥ 100,000/mm³
• Bilirubin \< 1.4 mg/dL
• WBC ≥ 3,000/mm³
• INR ≤ 1.5
• No known AIDS
• * HIV-positive patients without AIDS are eligible
• * HIV test required for patients with clinical suspicion of AIDS
• No other invasive malignancy within the past 3 years except for nonmelanomatous skin cancer
• No severe, active comorbidity, defined as any of the following:
• * Unstable angina and/or congestive heart failure requiring hospitalization within the past 6 months
• * Transmural myocardial infarction within the past 6 months
• * Acute bacterial or fungal infection requiring IV antibiotics
• * Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study treatment
• * Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
• * Uncontrolled diabetes mellitus, uncompensated heart disease, and/or uncontrolled high blood pressure, that in the opinion of the patient's treating physician, requires an immediate change in management
• * Other immunocompromised status (e.g., organ transplantation or chronic glucocorticoid use)
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• PRIOR CONCURRENT THERAPY:
• See Disease Characteristics
• No prior radiation therapy to the pelvis that would result in overlap of radiation therapy fields
• No prior systemic chemotherapy for cancer of the anus
• No prior surgery for cancer of the anus that removed all macroscopic anal cancer
• No concurrent sargramostim (GM-CSF)
• No concurrent amifostine