Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Int J Radiat Oncol Biol Phys. 2018 Sep 1;102(1):102-108. doi: 10.1016/j.ijrobp.2018.04.076. Epub 2018 May 5.
To report cancer control rates and adverse events (AEs) of curative-intent, extended-field chemoradiation therapy administered to patients with squamous cell carcinoma (SCC) of the anal canal presenting with distant metastasis limited to the para-aortic (PA) lymph nodes.
This was a retrospective review of patients with SCC of the anal canal metastatic to the PA lymph nodes at initial diagnosis who were treated with curative-intent, extended-field chemoradiation therapy between September 2002 and February 2016 at two tertiary care centers. Outcomes assessed included treatment-related AEs (Common Terminology Criteria for Adverse Events, version 4.0), disease control (cumulative incidence estimates), and survival (Kaplan-Meier estimates).
Thirty patients were included. Involved and elective PA nodes were treated to median doses of 51 Gy (range 45-57.6) and 45 Gy (range 30.6-50.4) in 29 fractions (range 17-32). All patients received one of these concomitant regimens: 6 weekly cycles of cisplatin with 5-fluoruracil/capecitabine (5-FU) (n = 22), 2 cycles of mitomycin-C with 5-FU (n = 7), or daily capecitabine (n = 1). After a median follow-up period of 3.1 years, 18 patients (60%) remained alive and 17 patients were without evidence of anal cancer after definite and salvage treatments. Overall and disease-free survival at 3 years was 67% (95% CI 49%-89%) and 42% (95% CI 25%-69%). Fifteen (50%) patients experienced a recurrence at a median of 0.9 year (range 0.5-3.5 years). The predominant site of recurrence was distant metastases, with a 3-year cumulative incidence of 50% (95% CI 20%-68%). There was no acute grade 5 AE. Grade 3 to 4 gastrointestinal, dermatologic, and hematologic AEs occurred in 30%, 27%, and 20% of patients respectively.
Extended-field chemoradiation therapy is a potentially curative treatment option for patients presenting with SCC of the anal canal with metastases limited to the PA lymph nodes.
报告局限于腹主动脉旁（PA）淋巴结的远处转移的肛管鳞癌（SCC）患者接受根治性、扩展野放化疗的癌症控制率和不良事件（AE）。
这是对 2002 年 9 月至 2016 年 2 月在两家三级护理中心接受根治性、扩展野放化疗治疗的初始诊断时 PA 淋巴结转移的 SCC 患者的回顾性研究。评估的结果包括治疗相关的 AE（不良事件通用术语标准 4.0 版）、疾病控制（累积发生率估计）和生存（Kaplan-Meier 估计）。
纳入 30 例患者。接受治疗的转移的 PA 淋巴结和预防性 PA 淋巴结中位剂量分别为 51 Gy（范围 45-57.6）和 45 Gy（范围 30.6-50.4），共 29 个疗程（范围 17-32）。所有患者均接受了以下方案之一：每周 6 个周期的顺铂联合氟尿嘧啶/卡培他滨（5-FU）（n=22）、2 个周期的丝裂霉素-C 联合 5-FU（n=7）或卡培他滨（n=1）。中位随访 3.1 年后，18 例患者（60%）存活，17 例患者在明确和挽救治疗后无肛门癌证据。3 年总生存率和无病生存率分别为 67%（95%CI 49%-89%）和 42%（95%CI 25%-69%）。15 例（50%）患者在中位时间 0.9 年（范围 0.5-3.5 年）时出现复发。复发的主要部位为远处转移，3 年累积发生率为 50%（95%CI 20%-68%）。无急性 5 级 AE。3-4 级胃肠道、皮肤和血液学 AE 分别发生在 30%、27%和 20%的患者中。
对于局限于 PA 淋巴结的 SCC 患者，扩展野放化疗是一种有潜在治愈可能的治疗选择。
