Department of Radiation Oncology, Boston Medical Center, Boston, MA 02118, USA.
Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):153-8. doi: 10.1016/j.ijrobp.2010.09.030. Epub 2010 Nov 20.
Chemoradiation for anal cancer yields effective tumor control, but is associated with significant acute toxicity. We report our multi-institutional experience using dose-painted IMRT (DP-IMRT).
Between August 2005 and May 2009, 43 patients were treated with DP-IMRT and concurrent chemotherapy for biopsy-proven, squamous cell carcinoma of the anal canal at two academic medical centers. DP-IMRT was prescribed as follows: T2N0: 42 Gy, 1.5 Gy/fraction (fx) to elective nodal planning target volume (PTV) and 50.4 Gy, 1.8 Gy/fx to anal tumor PTV; T3-4N0-3: 45 Gy, 1.5 Gy/fx to elective nodal PTV, and 54 Gy, 1.8 Gy/fx to the anal tumor and metastatic nodal PTV >3 cm with 50.4 Gy, 1.68 Gy/fx to nodal PTVs ≤ 3 cm in size. Acute and late toxicity was reported by the treating physician. Actuarial analysis was performed using the Kaplan-Meier method.
Median age was 58 years; 67% female; 16% Stage I, 37% II; 42% III; 5% IV. Fourteen patients were immunocompromised: 21% HIV-positive and 12% on chronic immunosuppression. Median follow-up was 24 months (range, 0.6-43.5 months). Sixty percent completed chemoradiation without treatment interruption; median duration of treatment interruption was 2 days (range, 2-24 days). Acute Grade 3+ toxicity included: hematologic 51%, dermatologic 10%, gastrointestinal 7%, and genitourinary 7%. Two-year local control, overall survival, colostomy-free survival, and metastasis-free survival were 95%, 94%, 90%, and 92%, respectively.
Dose-painted IMRT appears effective and well-tolerated as part of a chemoradiation therapy regimen for the treatment of anal canal cancer.
针对肛门癌的放化疗可有效控制肿瘤，但会伴随严重的急性毒性。我们报告了在两个学术医疗中心，应用剂量涂抹调强放疗（DP-IMRT）的多机构经验。
2005 年 8 月至 2009 年 5 月，43 例经活检证实的肛门管鳞癌患者在两个学术医疗中心接受 DP-IMRT 联合化疗。DP-IMRT 处方如下：T2N0：42 Gy，1.5 Gy/次（fx），计划靶区（PTV）的选择性淋巴结和 50.4 Gy，1.8 Gy/fx 至肛门肿瘤 PTV；T3-4N0-3：45 Gy，1.5 Gy/fx 至选择性淋巴结 PTV，54 Gy，1.8 Gy/fx 至肛门肿瘤和转移性淋巴结 PTV >3 cm，淋巴结 PTVs≤3 cm 大小者给予 50.4 Gy，1.68 Gy/fx。治疗医师报告急性和迟发性毒性。采用 Kaplan-Meier 法进行生存分析。
中位年龄 58 岁；67%为女性；16%为Ⅰ期，37%为Ⅱ期，42%为Ⅲ期，5%为Ⅳ期。14 例患者免疫功能低下：21%HIV 阳性，12%慢性免疫抑制。中位随访时间 24 个月（0.6-43.5 个月）。60%的患者完成了放化疗而无治疗中断；中位治疗中断时间为 2 天（2-24 天）。急性 3 级以上毒性包括：血液学 51%，皮肤病学 10%，胃肠道 7%，泌尿生殖系统 7%。2 年局部控制率、总生存率、无结直肠造口生存率和无转移生存率分别为 95%、94%、90%和 92%。
作为放化疗治疗肛门管癌方案的一部分，剂量涂抹调强放疗显示出有效性和良好耐受性。
