Gryc Thomas, Ott Oliver, Putz Florian, Knippen Stefan, Raptis Dimitrios, Fietkau Rainer, Strnad Vratislav
Department of Radiation Oncology, University Hospital of Erlangen, Erlangen, Germany.
Department of General Surgery, University Hospital of Erlangen, Erlangen, Germany.
Brachytherapy. 2016 Nov-Dec;15(6):865-872. doi: 10.1016/j.brachy.2016.08.003. Epub 2016 Oct 4.
To analyze the efficacy of a protocol-based brachytherapy (BT) boost after external beam radiation therapy (EBRT) with simultaneous chemotherapy in patients with anal carcinoma.
About 190 patients have been analyzed. Around 143 patients were identified with a good clinical response at the end of EBRT. Another 47 patients received an additional BT boost to the residual tumor at 6 weeks after end of chemoradiation.
The 5-year incidence of local recurrence was 24% in patients with BT boost and 19% in patients without BT boost (p = 0.238). The 5-year disease-free survival rate, overall survival rate, and colostomy-free survival rate were 64% and 75% and 76.1% in the BT group and 69% (p = 0.212), 72% (p = 0.924), and 82.7% (p = 0.488) in the non-BT group. We found no differences in late toxicity between the groups.
For patients with anal cancer with not a good response to 50-59 Gy EBRT with simultaneous chemotherapy, the further dose escalation using the BT boost up to a mean of 67.5 Gy seems to improve the clinical outcome to the same level as observed in patients with a good response to ERBT, without an increase in late side effects.
分析基于方案的近距离放射治疗（BT）在肛管癌患者同步化疗后外照射放疗（EBRT）基础上进行增敏治疗的疗效。
共分析了约190例患者。约143例患者在EBRT结束时具有良好的临床反应。另外47例患者在放化疗结束6周后对残留肿瘤进行了额外的BT增敏治疗。
接受BT增敏治疗的患者5年局部复发率为24%，未接受BT增敏治疗的患者为19%（p = 0.238）。BT组的5年无病生存率、总生存率和无结肠造口生存率分别为64%、75%和76.1%，非BT组分别为69%（p = 0.212）、72%（p = 0.924）和82.7%（p = 0.488）。我们发现两组之间的晚期毒性没有差异。
对于对50 - 59 Gy EBRT同步化疗反应不佳的肛管癌患者，使用BT增敏进一步提高剂量至平均67.5 Gy似乎能将临床结局改善至与对ERBT反应良好的患者相同水平，且不会增加晚期副作用。
