Allal A S, Laurencet F M, Reymond M A, Kurtz J M, Marti M C
Division of Radiation Oncology, Geneva University Hospital, Switzerland.
Cancer. 1999 Aug 1;86(3):405-9. doi: 10.1002/(sici)1097-0142(19990801)86:3<405::aid-cncr7>3.0.co;2-q.
Locally persistent or recurrent anal carcinoma represents a clinically significant problem, the management of which remains the subject of some controversy. Although the few current data suggest that radical surgery remains the sole salvage treatment able to provide some chance of cure, some authors have reported disappointingly low success rates. The current study presents the outcome of patients who failed locally after receiving radiotherapy or chemoradiotherapy for anal carcinoma.
Of 185 consecutive patients treated between January 1976 and December 1996 with sphincter conservation, 42 subsequently presented with local failure, either alone (27 patients) or with regional or distant metastases (15 patients). Nine patients (21%) received supportive care only, 7 patients (17%) received palliative therapy, and 26 patients (62%) underwent potentially curative surgical salvage treatment, including 23 abdominoperineal resections (APR) and 3 local excisions. The median follow-up after local failure for all patients was 21.5 months (range, 1-231 months).
With the exception of 2 patients who committed suicide, all patients who did not undergo surgical salvage therapy died of progressive disease. Among 26 patients who received curative treatment, 11 ultimately achieved disease control. The 5-year overall survival rate after the diagnosis of local failure was 28% for all patients and 44.5% for those receiving curative salvage treatment. For the latter group the 5-year actuarial secondary local and locoregional control rates were 53% and 43%, respectively.
Although APR no longer is the first-line treatment of patients with anal carcinoma, it continues to play an essential role in salvage therapy, resulting in ultimate disease control in approximately 50% of patients with isolated local failure. The curative potential of secondary surgical treatment suggests the possible importance of early detection of persistent or recurrent local disease after nonsurgical, sphincter-conserving therapy.
局部持续性或复发性肛管癌是一个具有临床重要意义的问题，其治疗仍存在一些争议。尽管目前为数不多的数据表明根治性手术仍然是唯一能够提供治愈机会的挽救性治疗方法，但一些作者报告的成功率低得令人失望。本研究展示了肛管癌患者在接受放疗或放化疗后出现局部治疗失败的结果。
在1976年1月至1996年12月期间连续接受保肛治疗的185例患者中，42例随后出现局部失败，单独局部失败（27例患者）或伴有区域或远处转移（15例患者）。9例患者（21%）仅接受支持治疗，7例患者（17%）接受姑息治疗，26例患者（62%）接受了可能治愈性的手术挽救治疗，包括23例腹会阴联合切除术（APR）和3例局部切除术。所有患者局部失败后的中位随访时间为21.5个月（范围1 - 231个月）。
除2例自杀患者外，所有未接受手术挽救治疗的患者均死于疾病进展。在接受治愈性治疗的26例患者中，11例最终实现了疾病控制。所有患者在局部失败诊断后的5年总生存率为28%，接受治愈性挽救治疗的患者为44.5%。对于后一组患者，5年精算二次局部和区域控制率分别为53%和43%。
尽管APR不再是肛管癌患者的一线治疗方法，但它在挽救治疗中继续发挥着重要作用，大约50%孤立局部失败的患者最终实现了疾病控制。二次手术治疗的治愈潜力表明，在非手术保肛治疗后早期发现持续性或复发性局部疾病可能具有重要意义。
