Kocáková I, Kocák I, Vyzula R, Perková H
Klinika komplexní onkologické péce-oddĕlení radiacní onkologie, Masarykův onkologický ústav, Brno.
Cas Lek Cesk. 2003;142 Suppl 1:36-9.
Carcinoma of the anal canal represents about 1-2% of digestive system cancers. Its prognosis depends directly upon the size of the primary tumor and on the probability of lymphatic spread of the cancer. In the past, patients with invasive anal carcinoma were routinely treated with abdominal perineal resection. The NCCN institutions recommend that patients who have a carcinoma in situ can be cured with local excision with adequate margins. If margins are not sufficient, local radiotherapy is desirable. Patients who have a T1 lesion receive external beam radiotherapy (50-59 Gy) plus or minus mitomycin/5-fluorouracil. Patients with T2-T4 lesion, especially if inguinal nodes are positive, should receive the combination of mitomycin/5-fluorouracil plus radiotherapy (50-59 Gy) to include the inguinal and pelvic lymph node regions. Patients receiving the combination therapy (chemotherapy with radiation therapy) when compared with those with radiation therapy alone have a significantly better local control (60% versus 39%). Patients whose tumor was not eradicated are candidates for additional chemotherapy with 5-fluorouracil/cisplatin. If the local disease is persistent or progressive or if it has the local recurrence, patient becomes a candidate for an abdominoperineal resection.
肛管癌约占消化系统癌症的1%-2%。其预后直接取决于原发肿瘤的大小以及癌症淋巴转移的可能性。过去，浸润性肛管癌患者通常接受腹会阴切除术治疗。美国国立综合癌症网络（NCCN）机构建议，原位癌患者可通过足够切缘的局部切除治愈。如果切缘不足，则需要局部放疗。T1期病变患者接受外照射放疗（50-59 Gy），加或不加丝裂霉素/5-氟尿嘧啶。T2-T4期病变患者，尤其是腹股沟淋巴结阳性者，应接受丝裂霉素/5-氟尿嘧啶联合放疗（50-59 Gy），照射范围包括腹股沟和盆腔淋巴结区域。与单纯放疗的患者相比，接受联合治疗（化疗联合放疗）的患者局部控制效果明显更好（60%对39%）。肿瘤未根除的患者可选择用5-氟尿嘧啶/顺铂进行额外化疗。如果局部疾病持续或进展，或者出现局部复发，患者可考虑接受腹会阴切除术。
