Abstract
While the standard of care for anal cancer consists of concurrent chemoradiation, patients with advanced T stages often succumb to local failures. Salvage treatment consists of an abdominoperineal resection (APR). While this is a good surgery to treat the local recurrence, there may be a risk of obtaining a positive margin due to the advanced nature and location of the recurrence. Addressing these high-risk positive margin sites with adjuvant brachytherapy after surgical resection is a good option to deliver a high dose of radiation to the R1 resection site while sparing the adjacent critical organs at risk. Herein, we present a case report of two patients with persistent or recurrent anal cancer who were treated with an APR with placement of a custom Cesium-131 brachytherapy mesh implant.