The aim of this report was to relate our experience in the management of anal cancer. Up to now, the standard treatment reported in the literature for this particular disease is combination chemo-radiotherapy in most patients. Management decisions such as radical chemotherapy, surgical resection for poor response or relapses are frequently modified by some factors such as disease stage, social and psychological status of the patient, age-associated comorbidity factors. From 1992 to 1998, 24 consecutive patients (median age: 64 years) with untreated epidermoid carcinoma of the anus (T2, 58%; T3, 42%; N+, 25%) were treated, as first-line therapy, with a simultaneous chemo-radiotherapy combination. The crude mortality rate was 34%, with 29% dying of their disease. The stage distribution and the amount of chemo-radiotherapy administered were not age-limited but younger patients had more surgery and suffered less toxicity with a greater proportion remaining alive and disease-free. These data suggest that a more aggressive multi-modality approach may improve disease-free response and survival.