Division of Oncology, Geneva University Hospital, Geneva, Switzerland.
Dis Colon Rectum. 2011 May;54(5):566-9. doi: 10.1007/DCR.0b013e31820d8333.
Fistulas arising from the perforation of anal cancer into adjacent organs are a debilitating complication in the course of the disease.
We studied intra-arterial chemotherapy as a strategy to close such fistulas before the initiation of standard chemoradiation.
This study was based on a retrospective chart review.
The investigation was conducted at Geneva University Hospital.
Eight patients with anal cancer-related fistulas were included in the study.
Patients were treated at our institution from 2002 to 2009 with upfront chemotherapy consisting of 1 to 4 cycles of intra-arterial cisplatin, 5-fluorouracil, methotrexate, and mitomycin C, and intravenous bleomycin. Intra-arterial chemotherapy was followed by standard chemoradiation.
Fistula closure was assessed by an expert proctologist.
Complete closure of fistulas was documented in 7 of 8 patients. Toxicity was manageable and consisted mainly of thrombocytopenia, neutropenia, and febrile neutropenia as well as fatigue.
This is a retrospective, uncontrolled review of only 8 patients and thus a meaningful comparison with standard chemoradiation is not feasible.
Upfront intra-arterial chemotherapy is a promising strategy to close anal cancer-related fistulas before initiating chemoradiation, potentially obviating the need for hazardous reconstructive surgery after radiotherapy.
肛门癌穿孔导致邻近器官瘘管是疾病进程中的一种使人虚弱的并发症。
我们研究了在开始标准放化疗之前，经动脉化疗作为关闭此类瘘管的策略。
这是一项基于回顾性图表审查的研究。
该研究在日内瓦大学医院进行。
本研究纳入了 8 例肛门癌相关瘘管患者。
2002 年至 2009 年，患者在我院接受了初始化疗，包括 1 至 4 个周期的顺铂、5-氟尿嘧啶、甲氨蝶呤和丝裂霉素 C 经动脉化疗，以及静脉博来霉素化疗。经动脉化疗后行标准放化疗。
瘘管闭合由专家直肠病学家评估。
7 例患者的瘘管完全闭合。毒性可管理，主要包括血小板减少症、中性粒细胞减少症和发热性中性粒细胞减少症以及疲劳。
这是一项对 8 例患者的回顾性、非对照研究，因此与标准放化疗的有意义比较不可行。
在开始放化疗之前，进行初始经动脉化疗是一种很有前途的策略，可以关闭肛门癌相关瘘管，从而可能避免在放疗后需要进行危险的重建手术。
