Antoine Lacassagne Cancer Center, Nice, France.
Int J Radiat Oncol Biol Phys. 2011 Jul 1;80(3):712-20. doi: 10.1016/j.ijrobp.2010.02.055. Epub 2010 Jul 7.
To retrospectively assess the clinical outcome in anal cancer patients treated with split-course radiation therapy and boosted through external-beam radiation therapy (EBRT) or brachytherapy (BCT).
From January 2000 to December 2004, a selected group (162 patients) with invasive nonmetastatic anal squamous cell carcinoma was studied. Tumor staging reported was T1 = 31 patients (19%), T2 = 77 patients (48%), T3 = 42 patients (26%), and T4= 12 patients (7%). Lymph node status was N0-1 (86%) and N2-3 (14%). Patients underwent a first course of EBRT: mean dose 45.1 Gy (range, 39.5-50) followed by a boost: mean dose 17.9 Gy (range, 8-25) using EBRT (76 patients, 47%) or BCT (86 patients, 53%). All characteristics of patients and tumors were well balanced between the BCT and EBRT groups.
The mean overall treatment time (OTT) was 82 days (range, 45-143) and 67 days (range, 37-128) for the EBRT and BCT groups, respectively (p < 0.001). The median follow-up was 62 months (range, 2-108). The 5-year cumulative rate of local recurrence (CRLR) was 21%. In the univariate analysis, the prognostic factors for CRLR were as follows: T stage (T1-2 = 15% vs. T3-4 = 36%, p = 0.03), boost technique (BCT = 12% vs. EBRT = 33%, p = 0.002) and OTT (OTT <80 days = 14%, OTT ≥80 days = 34%, p = 0.005). In the multivariate analysis, BCT boost was the unique prognostic factor (hazard ratio = 0.62 (0.41-0.92). In the subgroup of patients with OTT <80 days, the 5-year CRLR was significantly increased with the BCT boost (BC = 9% vs. EBRT = 28%, p = 0.03). In the case of OTT ≥80 days, the 5-year CRLR was not affected by the boost technique (BCT = 29% vs. EBRT = 38%, p = 0.21).
In anal cancer, when OTT is <80 days, BCT boost is superior to EBRT boost for CRLR. These results suggest investigating the benefit of BCT boost in prospective trials.
回顾性分析接受分割放疗并通过外照射放疗（EBRT）或近距离放疗（BCT）进行强化治疗的肛门癌患者的临床结果。
从 2000 年 1 月至 2004 年 12 月，选择了一组患有侵袭性非转移性肛门鳞癌的患者（162 例）进行研究。报告的肿瘤分期为 T1 = 31 例（19%），T2 = 77 例（48%），T3 = 42 例（26%），T4 = 12 例（7%）。淋巴结状态为 N0-1（86%）和 N2-3（14%）。患者接受了第一疗程的 EBRT：平均剂量为 45.1 Gy（范围为 39.5-50），随后进行了强化治疗：平均剂量为 17.9 Gy（范围为 8-25），使用 EBRT（76 例，47%）或 BCT（86 例，53%）。BCT 和 EBRT 组患者的所有特征和肿瘤均平衡良好。
EBRT 和 BCT 组的平均总治疗时间（OTT）分别为 82 天（范围为 45-143）和 67 天（范围为 37-128）（p < 0.001）。中位随访时间为 62 个月（范围为 2-108）。局部复发累积率（CRLR）的 5 年累积率为 21%。单因素分析显示，CRLR 的预后因素如下：T 期（T1-2 = 15%比 T3-4 = 36%，p = 0.03）、强化技术（BCT = 12%比 EBRT = 33%，p = 0.002）和 OTT（OTT <80 天 = 14%，OTT ≥80 天 = 34%，p = 0.005）。多因素分析显示，BCT 强化是唯一的预后因素（风险比=0.62（0.41-0.92））。在 OTT <80 天的患者亚组中，BCT 强化显著增加了 5 年 CRLR（BC = 9%比 EBRT = 28%，p = 0.03）。在 OTT ≥80 天的情况下，强化技术对 CRLR 没有影响（BCT = 29%比 EBRT = 38%，p = 0.21）。
在肛门癌中，当 OTT <80 天时，BCT 强化比 EBRT 强化更能降低 CRLR。这些结果表明，在前瞻性试验中研究 BCT 强化的益处。
