Chuong Michael D, Freilich Jessica M, Hoffe Sarah E, Fulp William, Weber Jill M, Almhanna Khaldoun, Dinwoodie William, Rao Nikhil, Meredith Kenneth L, Shridhar Ravi
Department of Radiation Oncology.
Gastrointest Cancer Res. 2013 Mar;6(2):39-45.
We compared our institutional experience using 3D conformal radiation therapy (3DCRT) vs. IMRT (intensity-modulated radiation therapy) for anal cancer.
We performed a single-institution retrospective review of all patients with squamous cell carcinoma anal cancer treated from September 2000 through September 2011, using definitive chemoradiation with curative intent.
This study included 89 consecutive patients (37 3DCRT, 52 IMRT). Median follow-up for all patients, IMRT patients alone, and CRT patients alone was 26.5 months (range, 3.5-133.6), 20 months (range, 3.5-125.5), and 61.9 months (range, 7.6-133.6), respectively. Three-year overall survival (OS), progression-free survival (PFS), locoregional control (LRC), and colostomy-free survival (CFS) were 91.1%, 82.3%, 90.8%, and 91.3% in the IMRT cohort and 86.1%, 72.5%, 91.9%, and 93.7% in the 3DCRT group (all P > .1). More patients in the 3DCRT group required a treatment break (11 vs. 4; P = .006), although the difference in median treatment break duration was not significant (12.2 vs. 8.0 days; P = .35). Survival did not differ based on whether a treatment break was needed (all P > .1). Acute grade ≥3 nonhematologic toxicity was decreased in the IMRT cohort (21.1 vs. 59.5%; P < .0001). Acute grade ≥3 skin toxicity was worse in the 3DCRT group (P < .0001), whereas an improvement in late grade ≥3 gastrointestinal (GI) toxicity was observed in the IMRT patients (P = .012).
This study is the largest thus far to compare 3DCRT and IMRT for definitive treatment of anal cancer. Although long-term outcomes did not significantly differ based on RT technique, a marked decrease in adverse effects and the need for a treatment break was achieved with IMRT.
我们比较了本机构使用三维适形放射治疗（3DCRT）与调强放射治疗（IMRT）治疗肛管癌的经验。
我们对2000年9月至2011年9月期间接受根治性放化疗的所有肛管鳞状细胞癌患者进行了单机构回顾性研究。
本研究纳入了89例连续患者（37例接受3DCRT，52例接受IMRT）。所有患者、仅IMRT患者和仅CRT患者的中位随访时间分别为26.5个月（范围3.5 - 133.6个月）、20个月（范围3.5 - 125.5个月）和61.9个月（范围7.6 - 133.6个月）。IMRT队列的3年总生存率（OS）、无进展生存率（PFS）、局部区域控制率（LRC）和无结肠造口生存率（CFS）分别为91.1%、82.3%、90.8%和91.3%，3DCRT组分别为86.1%、72.5%、91.9%和93.7%（所有P > 0.1）。3DCRT组更多患者需要治疗中断（11例 vs. 4例；P = 0.006），尽管中位治疗中断持续时间的差异不显著（12.2天 vs. 8.0天；P = 0.35）。生存情况在是否需要治疗中断方面无差异（所有P > 0.1）。IMRT队列中急性≥3级非血液学毒性有所降低（21.1% vs. 59.5%；P < 0.0001）。3DCRT组急性≥3级皮肤毒性更严重（P < 0.0001），而IMRT患者晚期≥3级胃肠道（GI）毒性有所改善（P = 0.012）。
本研究是迄今为止比较3DCRT和IMRT对肛管癌进行根治性治疗的最大规模研究。尽管基于放疗技术的长期结果无显著差异，但IMRT显著降低了不良反应和治疗中断的需求。
