Janssen Stefan, Glanzmann Christoph, Bauerfeind Peter, Stieb Sonja, Studer Gabriela, Brown Michelle, Riesterer Oliver
Departments of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
Radiat Oncol. 2014 Sep 8;9:199. doi: 10.1186/1748-717X-9-199.
To evaluate feasibility and outcome of our institutional SIB-IMRT schedule in patients with anal cancer and to selectively review the literature on different SIB-IMRT schedules.
Between 01/08-06/13 25 patients with biopsy proven squamous cell anal cancer were treated in our institution with IMRT. Radiotherapy was delivered in two series using a SIB-IMRT schedule of 45 Gy/1.8 Gy to the primary tumor and adjacent pelvic lymph nodes and 38 Gy/1.52 Gy to elective nodes followed by an IMRT boost of 7×2 Gy = 14 Gy to the primary tumor and involved nodes (cumulative prescription dose: 59 Gy).
Mean follow-up was 20 months (range: 4-68). The 2-year-local control, colostomy-free survival, distant metastases-free survival and overall survival rates were 92%, 92%, 92%, and 88%, respectively. Grade 3 acute skin toxicity was observed in 6 patients (24%). No high grade gastrointestinal or urinary acute toxicity occurred. Four patients required more than one day of treatment interruption due to acute toxicity. No grade 3 or higher late sequelae were observed.
We present our institutional SIB-IMRT experience treating patients with anal cancer in two series using moderate single doses from 1.5-2.0 Gy. Our results, in terms of loco-regional outcome and toxicity, were comparable to other studies. The incidence of treatment interruptions was very low. Therefore this schedule appears to be safe for clinical use.
评估我院采用同步整合加量调强放疗（SIB-IMRT）方案治疗肛管癌患者的可行性及疗效，并选择性回顾不同SIB-IMRT方案的相关文献。
2008年1月至2013年6月期间，我院对25例经活检证实为鳞状细胞肛管癌的患者进行了调强放疗。放疗分两个疗程进行，采用SIB-IMRT方案，对原发肿瘤及邻近盆腔淋巴结给予45 Gy/1.8 Gy的剂量，对选择性淋巴结给予38 Gy/1.52 Gy的剂量，随后对原发肿瘤及受累淋巴结给予7×2 Gy = 14 Gy的调强放疗推量（累积处方剂量：59 Gy）。
平均随访时间为20个月（范围：4 - 68个月）。2年局部控制率、无结肠造口生存率、无远处转移生存率和总生存率分别为92%、92%、92%和88%。6例患者（24%）出现3级急性皮肤毒性。未发生高级别胃肠道或泌尿系统急性毒性。4例患者因急性毒性需要中断治疗超过1天。未观察到3级或更高等级的晚期后遗症。
我们介绍了我院采用1.5 - 2.0 Gy的中等单次剂量分两个疗程治疗肛管癌患者的SIB-IMRT经验。我们在局部区域疗效和毒性方面的结果与其他研究相当。治疗中断的发生率非常低。因此，该方案似乎可安全用于临床。
