Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
Radiol Oncol. 2012 Jun;46(2):145-52. doi: 10.2478/v10019-012-0022-2. Epub 2012 Apr 11.
The aim of the retrospective study was to evaluate the effectiveness and toxicity of radiochemotherapy in patients with squamous cell carcinoma of the anal canal treated at a single institution.
Between 1/2003 and 9/2010, 84 patients were treated with radical radiochemotherapy at the Institute of Oncology Ljubljana, Slovenia. The treatment consisted of 3-dimensional conformal external beam radiotherapy with concurrent chemotherapy (5-fluorouracil and mytomycin C), followed by brachytherapy or external beam boost. The toxicity of therapy and its effectiveness were assessed.
The treatment was completed according to the protocol in 79.8% of patients. The median follow-up time of 55 survivors was 53 months (range: 16-105 months). The 5-year locoregional control (LRC), disease-free survival (DFS), disease-specific survival (DSS), overall survival (OS) and colostomy-free survival (CFS) rates were 71%, 68%, 81%, 67% and 85%, respectively. No treatment-related mortality was observed. The most frequent acute side-effect of the treatment was radiodermatitis (grade 3-4 in 58.2% of patients). LENT-SOMA grade 3-4 late radiation side effects were observed in 15 (18%) patients. In patients with brachytherapy boost a trend of less late side effects was observed compared to patients with external beam boost (P=0.066). On multivariate analysis, complete clinical disease response was identified as an independent prognostic factor for LRC, DFS and DSS, the salvage surgery for LRC and DFS, whereas Hb below 120 g/l retained its independent prognostic value for OS.
Radiochemotherapy provides an excellent disease control and the survival with preserving anal sphincter function in majority of patients. Surgical salvage with abdominoperineal resection for persistent or recurrent disease has curative potential.
本回顾性研究的目的是评估单一机构治疗的肛管鳞癌患者接受放化疗的疗效和毒性。
2003 年 1 月至 2010 年 9 月，84 例患者在斯洛文尼亚卢布尔雅那肿瘤研究所接受根治性放化疗。治疗包括三维适形外照射放疗联合同期化疗（5-氟尿嘧啶和丝裂霉素 C），随后行近距离放疗或外照射加量。评估了治疗的毒性及其有效性。
79.8%的患者按方案完成了治疗。55 例存活者的中位随访时间为 55 个月（范围：16-105 个月）。5 年局部区域控制（LRC）、无病生存（DFS）、疾病特异性生存（DSS）、总生存（OS）和无造口生存（CFS）率分别为 71%、68%、81%、67%和 85%。未观察到与治疗相关的死亡。最常见的急性治疗副作用是放射性皮炎（58.2%的患者为 3-4 级）。15 例（18%）患者出现 LENT-SOMA 3-4 级迟发性放射副作用。与外照射加量相比，近距离放疗加量的患者迟发性副作用较少（P=0.066）。多变量分析显示，完全临床疾病缓解是 LRC、DFS 和 DSS 的独立预后因素，挽救性手术是 LRC 和 DFS 的独立预后因素，而血红蛋白低于 120 g/L 则保留了 OS 的独立预后价值。
放化疗可使大多数患者获得良好的疾病控制和保留肛门括约肌功能的生存。对于持续性或复发性疾病，采用腹会阴联合切除术进行手术挽救具有治愈潜力。
