World J Gastroenterol. 2012 Nov 28;18(44):6349-56. doi: 10.3748/wjg.v18.i44.6349.
Oncological treatment is currently directed toward a tailored therapy concept. Squamous cell carcinoma of the anal canal could be considered a suitable platform to test new therapeutic strategies to minimize treatment morbidity. Standard of care for patients with anal canal cancer consists of a combination of radiotherapy and chemotherapy. This treatment has led to a high rate of local control and a 60% cure rate with preservation of the anal sphincter, thus replacing surgical abdominoperineal resection. Lymph node metastases represent a critical independent prognostic factor for local recurrence and survival. Mesorectal and iliac lymph nodes are usually included in the radiation field, whereas the inclusion of inguinal regions still remains controversial because of the subsequent adverse side effects. Sentinel lymph node biopsies could clearly identify inguinal node-positive patients eligible for therapeutic groin irradiation. A sentinel lymph node navigation procedure is reported here to be a feasible and effective method for establishing the true inguinal node status in patients suffering from anal canal cancer. Based on the results of sentinel node biopsies, a selective approach could be proposed where node-positive patients could be selected for inguinal node irradiation while node-negative patients could take advantage of inguinal sparing irradiation, thus avoiding toxic side effects.
目前，肿瘤治疗主要针对个体化治疗方案。肛管鳞癌可以作为一个合适的平台，用于测试新的治疗策略，以最大程度降低治疗的发病率。肛管癌患者的标准治疗包括放疗和化疗的联合治疗。这种治疗方法使局部控制率显著提高，肛门括约肌得以保留，患者的 60%可以被治愈，从而取代了传统的经腹会阴联合切除术。淋巴结转移是局部复发和生存的独立预后危险因素。中直肠和髂淋巴结通常包含在放射治疗野内，而腹股沟区的照射仍存在争议，因为这会导致严重的副作用。前哨淋巴结活检可以明确识别适合腹股沟区辅助照射的淋巴结阳性患者。本文报告了一种前哨淋巴结导航手术，这是一种可行且有效的方法，可以确定患有肛管癌患者的真正腹股沟淋巴结状态。根据前哨淋巴结活检的结果，可以提出一种选择性方法，对淋巴结阳性的患者进行腹股沟淋巴结照射，而淋巴结阴性的患者则可以进行腹股沟淋巴结预防性照射，从而避免毒性副作用。
