Kiran Ravi P, Pokala Naveen, Rottoli Matteo, Fazio Victor W
Cleveland Clinic Foundation, Department of Colorectal Surgery, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Am Surg. 2009 Feb;75(2):163-8.
Chemoradiotherapy is the standard treatment for anal cancer. Surgery is reserved for failure of therapy, but there are limited data examining outcomes after surgery. From a prospective population-based database on radiation and surgical therapy, we compare outcomes for patients with anal cancer undergoing rectal resection after radiation with patients undergoing radiation alone. Patients undergoing surgical resection of the rectum after initial radiation (SRT) for squamous cell carcinoma of the anus, anal canal, cloacogenic zone, and overlapping lesions of the rectum and anal canal from 1983 to 2002 were identified from the Surveillance, Epidemiology and End Results database. Patient and tumor characteristics of SRT were compared with those of patients who underwent radiation alone (RT). Survival was calculated by the Kaplan-Meier test. There were 1202 patients undergoing RT and 48 patients undergoing SRT. RT and SRT had similar median age, gender, and grade of tumor. SRT had more patients with regional stage of disease (66.7 vs 42.4%, P = 0.001). Mean survival for SRT was, however, similar to RT (103 vs 96 months, P = 0.8). For patients with localized stage, survival for SRT and RT was similar (105 vs 98 months, P = 0.7). For patients with regional stage, survival for SRT and RT was similar (95 vs 83 months, P = 0.6). The presence of regional disease appears to be associated with surgical resection after radiotherapy. Mean survival for such patients is comparable to that of patients undergoing radiation alone. Because radiation is combined with chemotherapy, this suggests that salvage surgery after failure of therapy results in outcomes comparable to combination therapy alone.
放化疗是肛管癌的标准治疗方法。手术用于治疗失败的情况，但关于手术后结局的研究数据有限。我们从一个基于人群的放疗和手术治疗前瞻性数据库中，比较了接受放疗后直肠切除术的肛管癌患者与单纯接受放疗患者的结局。从监测、流行病学和最终结果数据库中，识别出1983年至2002年期间因肛管、肛门管、泄殖腔源区以及直肠和肛门管重叠病变的鳞状细胞癌而在初始放疗后接受直肠手术切除（SRT）的患者。将SRT患者和肿瘤特征与单纯接受放疗（RT）的患者进行比较。采用Kaplan-Meier检验计算生存率。有1202例患者接受RT，48例患者接受SRT。RT和SRT患者的年龄中位数、性别和肿瘤分级相似。SRT患者区域疾病分期的比例更高（66.7%对42.4%，P = 0.001）。然而，SRT的平均生存期与RT相似（103个月对96个月，P = 0.8）。对于局限性疾病患者，SRT和RT的生存率相似（105个月对98个月，P = 0.7）。对于区域疾病患者，SRT和RT的生存率相似（95个月对83个月，P = 0.6）。区域疾病的存在似乎与放疗后手术切除有关。这类患者的平均生存期与单纯接受放疗的患者相当。由于放疗联合了化疗，这表明治疗失败后的挽救性手术导致的结局与单纯联合治疗相当。
