Penn State College of Medicine, Penn State Cancer Institute, Hershey, Pennsylvania, USA.
J Natl Compr Canc Netw. 2010 Jan;8(1):135-44. doi: 10.6004/jnccn.2010.0009.
Use of definitive chemoradiation as primary therapy for locoregional squamous cell carcinoma of the anal canal has been the standard approach in the United States since the 1980s. Over the past several years, phase III studies have shown that combination mitomycin C (MMC) and 5-fluorouracil (5-FU) concurrent with radiotherapy had better outcomes than radiotherapy alone or 5-FU with radiotherapy. Two recent phase III studies using diverse treatment strategies showed that cisplatin and 5-FU were not superior to 5-FU and MMC; in one of the trials, use of cisplatin-based chemoradiation resulted in a higher rate of colostomy compared with mitomycin-based chemoradiation. MMC and 5-FU concurrent with radiotherapy remains standard care. Further improvement is likely depending on an increased understanding of the molecular biology of anal carcinoma and the addition of relevant biologic agents to chemoradiation to overcome chemoradiation resistance.
自 20 世纪 80 年代以来，美国将明确的放化疗作为局部区域肛管鳞癌的主要治疗方法。在过去的几年中，III 期研究表明，与单独放疗或放疗联合 5-氟尿嘧啶（5-FU）相比，联合丝裂霉素 C（MMC）和 5-氟尿嘧啶（5-FU）的放化疗具有更好的疗效。最近两项使用不同治疗策略的 III 期研究表明，顺铂和 5-FU 并不优于 5-FU 和 MMC；在其中一项试验中，与 MMC 为基础的放化疗相比，顺铂为基础的放化疗导致结肠造口术的发生率更高。MMC 和 5-FU 联合放化疗仍然是标准治疗。进一步的改善可能取决于对肛门癌分子生物学的深入了解，以及将相关的生物制剂添加到放化疗中以克服放化疗耐药性。
