Serkies K, Bednaruk-Mlynski E, Dziadziuszko R, Jassem J
Department of Oncology and Radiotherapy, Medical University of Gdansk, 80-211 Gdansk, Poland.
Neoplasma. 2003;50(2):152-8.
Conservative treatment for carcinoma of the anus has become the standard care for this malignancy. In this study we report on our experience with this method with particular emphasis on treatment outcome and acute toxicity. Between April 1991 and February 2002, 35 patients (male/female ratio 0.35) with UICC T(1-i) N(0-3) M(0) squamous cell carcinoma of the anal canal or anal margin were treated with chemo-radiation (31 patients) or radiotherapy alone (4 patients). Three patients had previously undergone local tumor excision with anus preservation. The total tumor dose of 48 to 60 Gy was delivered either by split-course or continuous radiation therapy to the pelvis, followed by a local boost to the primary tumor. Chemotherapy included one or two cycles of mitomycin C (10-15 mg/m(2) day 1) and 5-fluorouracil (450-750 mg/m(2) day 1 to 4 or 5) given during the first and the last part of irradiation. Complete tumor remission was obtained in 26 (76%) out of 34 evaluable patients. Clinically persistent disease was found in five (17%) and three (7%) patients treated with chemo- radiation and radiation alone, respectively. In four of these cases salvage surgery was performed. With a median follow-up of 49 months (range 2-131 months) local recurrence occurred in four patients (12%), and distant metastases - in two (6%). Overall, local treatment failure was observed in twelve patients (35%) including eight with T3 and one with T4 tumor. Local control was maintained until the last follow-up or death in 22 patients (65%). An actuarial 5-year overall and colostomy-free survival rates were 63% (CI, 45-81%) and 45% (CI, 25-64%), respectively. Nineteen patients (54%) experienced acute toxicity, predominantly hematologic and gastrointestinal, and severe effects including one death occurred in 11 patients (31%). Late sequelae including chronic diarrhea, edema of genitalia and legs, impaired sexual activity, and bone fractures were observed in eight patients (24%). Moderate anal stool incontinence occurred in three patients (9%). In conclusion, conservative management of anal carcinoma allows durable colostomy-free survival in a proportion of patients. However, the risk of local failure is relatively high in patients with large primary tumors. Combined chemo-radiation is associated with relatively high rate of acute toxicity.
肛管癌的保守治疗已成为这种恶性肿瘤的标准治疗方法。在本研究中，我们报告了我们采用这种方法的经验，特别强调治疗结果和急性毒性。1991年4月至2002年2月期间，35例（男女比例为0.35）UICC T(1-i) N(0-3) M(0) 肛管或肛缘鳞状细胞癌患者接受了化疗放疗（31例）或单纯放疗（4例）。3例患者此前曾接受过保肛的局部肿瘤切除术。总肿瘤剂量48至60 Gy通过分割疗程或连续放疗给予盆腔，随后对原发肿瘤进行局部加量照射。化疗包括在放疗的第一阶段和最后阶段给予一或两个周期的丝裂霉素C（10 - 15 mg/m(2) 第1天）和5-氟尿嘧啶（450 - 750 mg/m(2) 第1至4或5天）。34例可评估患者中有26例（76%）实现了肿瘤完全缓解。分别有5例（17%）接受化疗放疗和3例（7%）接受单纯放疗的患者出现临床持续性疾病。其中4例患者接受了挽救性手术。中位随访49个月（范围2 - 131个月），4例患者（12%）出现局部复发，2例患者（6%）出现远处转移。总体而言，12例患者（35%）出现局部治疗失败，包括8例T3期和1例T4期肿瘤患者。22例患者（65%）在最后一次随访或死亡前维持了局部控制。5年总生存率和无结肠造口生存率的精算值分别为63%（CI，45 - 81%）和45%（CI，25 - 64%）。19例患者（54%）出现急性毒性，主要为血液学和胃肠道毒性，11例患者（31%）出现严重不良反应，包括1例死亡。8例患者（24%）出现晚期后遗症，包括慢性腹泻、生殖器和腿部水肿、性功能障碍以及骨折。3例患者（9%）出现中度肛门大便失禁。总之，肛管癌的保守治疗使一部分患者能够实现持久的无结肠造口生存。然而，原发肿瘤较大的患者局部失败风险相对较高。联合化疗放疗与较高的急性毒性发生率相关。
