Bagshaw Hilary P, Sause William T, Gawlick Ute, Kim H Tae, Whisenant Jonathan, Cannon George M
Stanford University Hospital and Clinics, Stanford, CA.
Intermountain Healthcare Radiation Oncology.
Am J Clin Oncol. 2018 May;41(5):492-496. doi: 10.1097/COC.0000000000000322.
The objective is to determine localregional control (LRC), distant metastasis free survival, disease-free survival, overall survival (OS), and toxicity for patients with squamous cell carcinoma of the anus treated with definitive chemotherapy and intensity-modulated radiation therapy (IMRT).
We conducted a retrospective review of patients treated using IMRT for squamous cell carcinoma of the anus at our institution since 2005. Patients with local recurrences were identified and reviewed. The Kaplan-Meier curves were used for LRC and OS.
From 2005 to 2014, 52 patients were treated with IMRT-based chemoradiation for squamous cell carcinoma of the anus. Median dose to the primary tumor was 54 Gy. LRC, distant metastasis free survival, OS, and disease-free survival were 92.3%, 88.5%, 86.5%, and 84.6%, respectively, with a median follow-up of 20 months. Two local failures occurred at the anal primary site and 2 in the vulva. Despite subsequent palliative radiotherapy and chemotherapy, neither patient with a vulvar recurrence achieved disease control.
In a cohort of patients treated with IMRT-based chemoradiation, 2 vulvar recurrences were identified within the avoided external genitalia despite limited recurrence rates within the cohort overall. This experience suggests that for patients with a locally advanced primary tumor and bulky bilateral inguinal or pelvic disease, the in-transit vulvar dermal lymphatics may be at risk for subclinical involvement and subsequent recurrence. If substantiated by a similar pattern of recurrence at other institutions, the external genitalia may need to be reclassified from an avoidance structure to a clinical treatment volume in patients with locally advanced anal cancer.
确定接受根治性化疗和调强放射治疗（IMRT）的肛管鳞状细胞癌患者的局部区域控制（LRC）、无远处转移生存期、无病生存期、总生存期（OS）及毒性反应。
我们对自2005年以来在本机构接受IMRT治疗肛管鳞状细胞癌的患者进行了回顾性研究。识别并评估局部复发的患者。采用Kaplan-Meier曲线分析LRC和OS。
2005年至2014年，52例患者接受了基于IMRT的肛管鳞状细胞癌放化疗。原发肿瘤的中位剂量为54 Gy。LRC、无远处转移生存期、OS和无病生存期分别为92.3%、88.5%、86.5%和84.6%，中位随访时间为20个月。在肛管原发部位发生2例局部复发，在外阴发生2例。尽管随后进行了姑息性放疗和化疗，但外阴复发的患者均未实现疾病控制。
在一组接受基于IMRT的放化疗的患者中，尽管总体队列中的复发率有限，但在避免照射的外生殖器区域内仍发现2例外阴复发。这一经验表明，对于局部晚期原发肿瘤且双侧腹股沟或盆腔有大块病变的患者，转移途中的外阴真皮淋巴管可能存在亚临床受累及随后复发的风险。如果其他机构出现类似的复发模式得到证实，对于局部晚期肛管癌患者，外生殖器可能需要从避免照射的结构重新分类为临床治疗靶区。
