Cummings B J, Keane T J, O'Sullivan B, Wong C S, Catton C N
Department of Radiation Oncology, Princess Margaret Hospital Toronto, Ontario, Canada.
Int J Radiat Oncol Biol Phys. 1991 Oct;21(5):1115-25. doi: 10.1016/0360-3016(91)90265-6.
One hundred ninety-two patients with primary epidermoid cancer of the anal canal were treated by a series of prospectively designed, sequential non-randomized protocols of radiation alone (RT), radiation with concurrent 5-Fluorouracil and Mitomycin C (FUMIR), or radiation with concurrent 5-Fluorouracil only (FUR). The 5-year cause-specific survival rates were 69% overall, 68% RT, 76% FUMIR, 64% FUR. The primary tumor was controlled by radiation with or without chemotherapy in 68% (130/191) overall, 56% (32/57) by RT, 86% (59/69) by FUMIR, 60% (39/65) by FUR. The results with FUMIR were significantly better than with either RT alone or FUR, and except in tumors up to 2 cm in size, this superiority was found in all T stages. Regional lymph node metastases were controlled in 33 of 38 (87%) overall. The finding of clinically detectable regional lymph node metastases at presentation did not affect survival significantly in any treatment group. Anorectal function was preserved in 88% of the patients in whom the primary tumor was controlled, and in 64% overall. The delivery of 5FU and MMC concurrently with uninterrupted radical irradiation, 50 Gy in 20 fractions in 4 weeks, produced severe acute and late normal tissue morbidity. Split course treatment, and reduction of the daily fractional dose to 2 Gy, diminished the severity of normal tissue damage. Omission of Mitomycin C reduced acute hematological toxicity, but was associated with a decreased primary tumor control rate. The most effective treatment protocols as measured by survival rates, primary anal tumor control rates, and the likelihood of conservation of anorectal function included the administration of both Mitomycin C and 5-Fluorouracil concurrently with radiation therapy.
192例原发性肛管表皮样癌患者接受了一系列前瞻性设计的、连续的非随机方案治疗，分别为单纯放疗（RT）、放疗联合5-氟尿嘧啶和丝裂霉素C（FUMIR）或单纯放疗联合5-氟尿嘧啶（FUR）。5年病因特异性生存率总体为69%，RT组为68%，FUMIR组为76%，FUR组为64%。总体上，68%（130/191）的原发性肿瘤通过放疗联合或不联合化疗得到控制，RT组为56%（32/57），FUMIR组为86%（59/69），FUR组为60%（39/65）。FUMIR方案的结果明显优于单纯RT或FUR方案，除了肿瘤大小达2 cm的情况外，在所有T分期中均发现了这种优势。总体上，38例中有33例（87%）的区域淋巴结转移得到控制。就诊时临床可检测到区域淋巴结转移这一情况在任何治疗组中对生存率均无显著影响。在原发性肿瘤得到控制的患者中，88%的患者保留了肛肠功能，总体保留率为64%。在4周内分20次给予50 Gy不间断根治性放疗的同时给予5FU和MMC，会产生严重的急性和晚期正常组织并发症。分割疗程治疗以及将每日分次剂量减至2 Gy，可减轻正常组织损伤的严重程度。省略丝裂霉素C可降低急性血液学毒性，但与原发性肿瘤控制率降低有关。以生存率、原发性肛管肿瘤控制率和保留肛肠功能的可能性衡量，最有效的治疗方案包括在放疗的同时给予丝裂霉素C和5-氟尿嘧啶。
