De Bari Berardino, Jumeau Raphael, Bouchaab Hasna, Vallet Véronique, Matzinger Oscar, Troussier Idriss, Mirimanoff René-Olivier, Wagner Anna Dorothea, Hanhloser Dieter, Bourhis Jean, Ozsahin Esat Mahmut
a Radiation Oncology Department , Centre Hospitalier Universitaire Vaudois (CHUV) , Lausanne , Switzerland ;
b Medical Oncology Department , Centre Hospitalier Universitaire Vaudois (CHUV) , Lausanne , Switzerland ;
Acta Oncol. 2016 Jun;55(6):767-73. doi: 10.3109/0284186X.2015.1120886. Epub 2016 Apr 1.
Background and purpose Intensity-modulated radiotherapy (IMRT), also using volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) techniques, has been only recently introduced for treating anal cancer patients. We report efficacy and safety HT, and daily image-guided RT (IGRT) for anal cancer. Materials and methods We retrospectively analyzed efficacy and toxicity of HT with or without chemotherapy for anal cancer patients. Local control (LC) and grade 3 or more toxicity rate (CTC-AE v.4.0) were the primary endpoints. Overall (OS), disease-free (DFS), and colostomy-free survival (CFS) are also reported. Results Between October 2007 and May 2014, 78 patients were treated. Fifty patients presented a stage II or stage IIIA (UICC 2002), and 33 presented a N1-3 disease. Radiotherapy consisted of 36 Gy (1.8 Gy/fraction) delivered on the pelvis and on the anal canal, with a sequential boost up to 59.4 Gy (1.8 Gy/fraction) delivered to the anal and to nodal gross tumor volumes. Concomitant chemotherapy was delivered in 73 patients, mainly using mitomycin C and 5-fluorouracil (n = 30) or mitomycin C and capecitabine combination (n = 37). After a median follow-up period of 47 months (range 3-75), the five-year LC rate was 83.8% (95% CI 76.2-91.4%). Seven patients underwent a colostomy because of local recurrence (n = 5) or pretreatment dysfunction (n = 2). Overall incidence of grade 3 acute toxicity was 24%, mainly as erythema (n = 15/19) or diarrhea (n = 7/19). Two patients presented a late grade 3 gastrointestinal toxicity (anal incontinence). No grade 4 acute or late toxicity was recorded. Conclusions HT with daily IGRT is efficacious and safe in the treatment of anal canal cancer patients, and is considered in our department standard of care in this clinical setting.
背景与目的 调强放射治疗（IMRT），也包括容积调强弧形治疗（VMAT）和螺旋断层放射治疗（HT）技术，直到最近才被用于治疗肛管癌患者。我们报告了HT以及每日影像引导放射治疗（IGRT）治疗肛管癌的疗效和安全性。材料与方法 我们回顾性分析了肛管癌患者接受HT联合或不联合化疗的疗效和毒性。局部控制（LC）和3级及以上毒性发生率（美国国立癌症研究所通用不良反应事件评价标准第4版）是主要终点。还报告了总生存期（OS）、无病生存期（DFS）和无结肠造口生存期（CFS）。结果 在2007年10月至2014年5月期间，共治疗了78例患者。50例为II期或IIIA期（国际抗癌联盟2002年分期），33例为N1 - 3期疾病。放射治疗包括在盆腔和肛管给予36 Gy（1.8 Gy/分次），随后序贯推量至59.4 Gy（1.8 Gy/分次），给予肛管和肿大淋巴结肿瘤体积。73例患者接受了同步化疗，主要使用丝裂霉素C和5 - 氟尿嘧啶（n = 30）或丝裂霉素C和卡培他滨联合方案（n = 37）。中位随访期47个月（范围3 - 75个月）后，5年LC率为83.8%（95%可信区间76.2 - 91.4%）。7例患者因局部复发（n = 5）或治疗前功能障碍（n = 2）接受了结肠造口术。3级急性毒性的总体发生率为24%，主要表现为红斑（n = 15/19）或腹泻（n = 7/19）。2例患者出现3级晚期胃肠道毒性（肛门失禁）。未记录到4级急性或晚期毒性。结论 每日IGRT的HT治疗肛管癌患者有效且安全，在我们科室被视为该临床情况下的标准治疗方法。
