Das Prajnan, Crane Christopher H, Ajani Jaffer A
Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Curr Opin Oncol. 2007 Jul;19(4):396-400. doi: 10.1097/CCO.0b013e32816f76de.
Chemoradiation represents the standard of care for most patients with localized squamous cell carcinoma of the anal canal. This article reviews randomized trials and recent studies on chemoradiation for anal cancer.
A recent randomized trial showed that patients treated with induction 5-fluorouracil/cisplatin followed by concurrent 5-fluorouracil/cisplatin and radiotherapy had a higher colostomy rate than patients treated with concurrent 5-fluorouracil/mitomycin C and radiotherapy. It remains unclear whether this difference in the rate of colostomy was due to the chemotherapy agents, the use of induction therapy in the 5-fluorouracil/cisplatin arm, or other factors. Recent studies have started to evaluate intensity modulated radiation therapy for anal cancer, in an effort to reduce acute and long-term toxicity from radiotherapy.
The role of cisplatin in anal cancer is not completely clear, although an ongoing randomized trial (Anal Cancer Trial II) may help clarify the role of cisplatin. Studies on tumor biology and patient genetics are warranted to identify patients that are most likely to benefit from newer locoregional and systemic therapies. Intensity modulated radiation therapy appears to be a promising approach for reducing treatment-related toxicity in anal cancer patients. The Radiation Therapy Oncology Group (RTOG) is conducting a phase II trial evaluating the multi-institutional feasibility of intensity modulated radiation therapy for anal cancer.
放化疗是大多数局部肛管鳞状细胞癌患者的标准治疗方法。本文回顾了肛管癌放化疗的随机试验和近期研究。
一项近期的随机试验表明，接受诱导性5-氟尿嘧啶/顺铂治疗，随后进行同步5-氟尿嘧啶/顺铂和放疗的患者，其结肠造口术发生率高于接受同步5-氟尿嘧啶/丝裂霉素C和放疗的患者。目前尚不清楚结肠造口术发生率的这种差异是由于化疗药物、5-氟尿嘧啶/顺铂组中诱导治疗的使用，还是其他因素所致。近期研究已开始评估肛管癌的调强放射治疗，以降低放疗的急性和长期毒性。
顺铂在肛管癌中的作用尚不完全明确，尽管一项正在进行的随机试验（肛管癌试验II）可能有助于阐明顺铂的作用。有必要开展肿瘤生物学和患者遗传学研究，以确定最有可能从更新的局部区域和全身治疗中获益的患者。调强放射治疗似乎是降低肛管癌患者治疗相关毒性的一种有前景的方法。放射肿瘤学组（RTOG）正在进行一项II期试验，评估调强放射治疗用于肛管癌的多机构可行性。
