Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
Cancer. 2011 Aug 1;117(15):3342-51. doi: 10.1002/cncr.25901. Epub 2011 Feb 1.
The purpose of this study was to compare outcomes in patients with anal canal squamous cell carcinoma (SCCA) who were treated with definitive chemoradiotherapy by either intensity-modulated radiation therapy (IMRT) or conventional radiotherapy (CRT).
Forty-six patients who received definitive chemoradiotherapy from January 1993 to August 2009 were included. Forty-five patients received 5-fluorouracil with mitomycin C (n = 39) or cisplatin (n = 6). Seventeen (37%) were treated with CRT and 29 (63%) with IMRT. The median dose was 54 Gy in both groups. Median follow-up was 26 months (CRT) and 32 months (IMRT). T3-T4 stage (P = .18) and lymph node-positive disease (P = .6) were similar between groups.
The CRT group required longer treatment duration (57 days vs 40 days, P < .0001), more treatment breaks (88% vs 34.5%, P = .001), and longer breaks (12 days vs 1.5 days, P < .0001) than patients treated with IMRT. Eleven (65%) patients in the CRT group experienced grade >2 nonhematologic toxicity compared with 6 (21%) patients in the IMRT group (P = .003). The 3-year overall survival (OS), locoregional control (LRC), and progression-free survival were 87.8%, 91.9%, and 84.2%, respectively, for the IMRT groups and 51.8%, 56.7%, and 56.7%, respectively, for the CRT group (all P < .01). On multivariate analysis, T stage, use of IMRT, and treatment duration were associated with OS, and T stage and use of IMRT were associated with LRC.
The use of IMRT was associated with less toxicity, reduced need for treatment breaks, and excellent LRC and OS compared with CRT in patients with SCCA of the anal canal.
本研究旨在比较接受根治性放化疗的肛管鳞癌（SCCA）患者的治疗结果，这些患者分别接受了调强放疗（IMRT）或常规放疗（CRT）。
本研究纳入了 1993 年 1 月至 2009 年 8 月期间接受根治性放化疗的 46 例患者。45 例患者接受了氟尿嘧啶联合丝裂霉素 C（n=39）或顺铂（n=6）治疗。17 例（37%）患者接受 CRT，29 例（63%）患者接受 IMRT。两组的中位剂量均为 54Gy。中位随访时间为 CRT 组 26 个月和 IMRT 组 32 个月。两组 T3-T4 期（P=0.18）和淋巴结阳性疾病（P=0.6）相似。
CRT 组的治疗持续时间（57 天 vs 40 天，P<0.0001）、治疗中断次数（88% vs 34.5%，P=0.001）和中断时间（12 天 vs 1.5 天，P<0.0001）均长于 IMRT 组。CRT 组 11 例（65%）患者发生≥2 级非血液学毒性，而 IMRT 组 6 例（21%）患者发生（P=0.003）。IMRT 组的 3 年总生存率（OS）、局部区域控制率（LRC）和无进展生存率分别为 87.8%、91.9%和 84.2%，而 CRT 组分别为 51.8%、56.7%和 56.7%（均 P<0.01）。多因素分析显示，T 分期、IMRT 的应用和治疗持续时间与 OS 相关，T 分期和 IMRT 的应用与 LRC 相关。
与 CRT 相比，IMRT 可降低毒性、减少治疗中断次数，并为肛管 SCC 患者带来更好的局部区域控制率和总生存率。
