Melcher A A, Sebag-Montefiore D
Leeds Cancer Centre, Cookridge Hospital, Hospital Lane, Leeds, West Yorkshire LS16 6QB, UK.
Br J Cancer. 2003 May 6;88(9):1352-7. doi: 10.1038/sj.bjc.6600913.
Chemoradiotherapy (CRT) is now widely accepted as the primary treatment modality for squamous cell cancer of the anus. While randomised trials have clearly shown CRT to be more effective than radiotherapy alone, there remains uncertainty over the optimal integration of chemotherapy and radiation. We describe a series of 50 patients treated by a site specialist gastrointestinal nonsurgical oncologist with CRT at a single UK centre. Chemotherapy comprised mitomycin C (MMC) (day 1) and 5-fluorouracil (5-FU) (days 1-4, and 29-32), concurrent with 50 Gy in 25 fractions radiation, using a two-phase shrinking field technique. A radiation boost was not planned. At a median follow-up of 48 months, 11 (22%) of the patients have failed locally, of which three have been surgically salvaged. Nine (18%) have died of anal cancer. These results are comparable with those from large randomised studies, and suggest that a two-phase shrinking field radiotherapy technique with no boost, concurrent with MMC/5-FU chemotherapy, is an effective regimen for this disease. The CRT regimen described here provides the basis for the 'control arm' of the current UK-randomised CRT trial in anal cancer (ACT2).
放化疗（CRT）目前已被广泛认可为肛管鳞状细胞癌的主要治疗方式。尽管随机试验已明确表明放化疗比单纯放疗更有效，但化疗与放疗的最佳联合方式仍存在不确定性。我们描述了英国一家中心的一位胃肠道非手术肿瘤专科医生采用放化疗治疗的50例患者。化疗方案为丝裂霉素C（MMC）（第1天）和5-氟尿嘧啶（5-FU）（第1 - 4天以及第29 - 32天），同时采用两阶段缩野技术进行25次分割、总剂量50 Gy的放疗。未计划进行放疗增敏。中位随访48个月时，11例（22%）患者出现局部复发，其中3例经手术挽救。9例（18%）患者死于肛管癌。这些结果与大型随机研究的结果相当，表明两阶段缩野放疗技术（不进行增敏）联合MMC/5-FU化疗是治疗该疾病的有效方案。本文所述的放化疗方案为目前英国肛管癌随机放化疗试验（ACT2）的“对照臂”提供了依据。
