Nigro N D, Vaitkevicius V K, Considine B
Department of Surgery, Wayne State University, Detroit, MI 48226.
Invest New Drugs. 1989 Apr;7(1):83-9. doi: 10.1007/BF00178194.
For many years the accepted treatment for squamous cell cancer of the anal canal has been abdominoperineal resection of the rectum. Recently, high dose radiation therapy has been advocated by some, and we initiated a study using a combination of radiation, chemotherapy and surgery. This review includes 44 patients treated by us from December 1971 to July 1983. We discontinued routine operation after 1975 because chemoradiation therapy eliminated the primary lesion in most patients. In fact, the gross lesion disappeared in 40 patients, 13 of whom had radical operations done on routine basis. Four operations were done for residual disease after chemoradiation treatment and one for local recurrence. The corrected, projected five year survival rate was 79% with a follow-up of at least four years in all patients. Most failures occurred in patients with large primary tumors, all of whom had radical operations after the preoperative therapy. This experience suggests that patients with primary lesions over 5 cm in maximum diameter should have an additional course of chemoradiation and/or abdominoperineal resection on a routine basis.
多年来，肛管鳞状细胞癌公认的治疗方法一直是直肠腹会阴切除术。最近，一些人主张采用高剂量放射治疗，我们开展了一项采用放疗、化疗和手术相结合的研究。本综述纳入了1971年12月至1983年7月期间我们治疗的44例患者。1975年后我们停止了常规手术，因为放化疗消除了大多数患者的原发病变。事实上，40例患者的肉眼可见病变消失，其中13例按常规进行了根治性手术。4例手术是针对放化疗后的残留病灶进行的，1例是针对局部复发进行的。所有患者至少随访4年，校正后的预计5年生存率为79%。大多数治疗失败发生在原发性肿瘤较大的患者中，所有这些患者在术前治疗后均进行了根治性手术。这一经验表明，最大直径超过5 cm的原发性病变患者应常规进行额外疗程的放化疗和/或腹会阴切除术。
