比较分析肛门癌患者同步整合增量调强与序贯增量调强的疗效：一项回顾性观察研究的结果。
Comparing simultaneous integrated boost vs sequential boost in anal cancer patients: results of a retrospective observational study.
机构信息
Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy.
Department of Radiation Oncology, Centre Hospitalier Régional Universitaire 'Jean Minjoz', Besançon, France.
出版信息
Radiat Oncol. 2018 Sep 10;13(1):172. doi: 10.1186/s13014-018-1124-9.
BACKGROUND
To evaluate clinical outcomes of simultaneous integrated boost (SIB) - intensity modulated radiotherapy (RT) in patients with non metastatic anal cancer compared to those of a set of patients treated with 3-dimensional conformal RT and sequential boost (SeqB).
METHODS
A retrospective cohort of 190 anal cancer patients treated at 3 academic centers with concurrent chemo-RT employing either SIB or SeqB was analysed. The SIB-group consisted of 87 patients, treated with 2 cycles of Mitomycin (MMC) and 5-Fluorouracil (5FU) using SIB-IMRT delivering 42-45Gy/28-30 fractions to the elective pelvic lymph nodes and 50.4-54Gy/28-30fractions to the primary tumor and involved nodes, based on pre-treatment staging. The SeqB group comprised 103 patients, treated with MMC associated to either 5FU or Capecitabine concurrent to RT with 36 Gy/20 fractions to a single volume including gross tumor, clinical nodes and elective nodal volumes and a SeqB to primary tumor and involved nodes of 23.4 Gy/13 fractions. We compared colostomy-free survival (CFS), overall survival (OS) and the cumulative incidence of colostomy for each radiation modality. Cox proportional-hazards model addressed factors influencing OS and CFS.
RESULTS
Median follow up was 34 (range 9-102) and 31 months (range 2-101) in the SIB and SeqB groups. The 1- and 2-year cumulative incidences of colostomy were 8.2% (95%CI:3.6-15.2) and 15.0% (95%CI:8.1-23.9) in the SIB group and 13.9% (95%CI: 7.8-21.8) and 18.1% (95%CI:10.8-27.0) in the SeqB group. Two-year CFS and OS were 78.1% (95%CI:67.0-85.8) and 87.5% (95%CI:77.3-93.3) in the SIB group and 73.5% (95%CI:62.6-81.7) and 85.4% (95%CI:75.5-91.6) in the SeqB, respectively. A Cox proportional hazards regression model highlighted an adjusted hazard ratio (AdjHR) of 1.18 (95%CI: 0.67-2.09;p = 0.560), although AdjHR for the first 24 months was 0.95 (95%CI: 0.49-1.84;p = 0.877) for the SIB approach.
CONCLUSIONS
SIB-based RT provides similar clinical outcomes compared to SeqB-based in the treatment of patients affected with non metastatic anal cancer.
背景
评估同时整合增强（SIB）-强度调制放疗（RT）与一系列采用三维适形 RT 和序贯增强（SeqB）治疗的非转移性肛门癌患者的临床结果。
方法
对在 3 个学术中心接受顺式化疗 RT 治疗的 190 例肛门癌患者的回顾性队列进行分析，其中 SIB 组 87 例，采用 SIB-IMRT 治疗，共 2 个周期的丝裂霉素（MMC）和 5-氟尿嘧啶（5FU），对选择性盆腔淋巴结和原发肿瘤及受累淋巴结分别给予 42-45Gy/28-30 分次和 50.4-54Gy/28-30 分次。SeqB 组 103 例，采用 MMC 联合 5FU 或卡培他滨同期放疗，给予单一体积 36Gy/20 分次，包括大体肿瘤、临床淋巴结和选择性淋巴结体积，原发肿瘤和受累淋巴结的 SeqB 为 23.4Gy/13 分次。我们比较了两种放射治疗方式的结肠造口术无复发生存（CFS）、总生存（OS）和结肠造口术累积发生率。Cox 比例风险模型分析了影响 OS 和 CFS 的因素。
结果
SIB 和 SeqB 组的中位随访时间分别为 34（9-102）和 31 个月（2-101）。SIB 组 1 年和 2 年的结肠造口术累积发生率分别为 8.2%（95%CI：3.6-15.2）和 15.0%（95%CI：8.1-23.9），SeqB 组分别为 13.9%（95%CI：7.8-21.8）和 18.1%（95%CI：10.8-27.0）。SIB 组的 2 年 CFS 和 OS 分别为 78.1%（95%CI：67.0-85.8）和 87.5%（95%CI：77.3-93.3），SeqB 组分别为 73.5%（95%CI：62.6-81.7）和 85.4%（95%CI：75.5-91.6）。Cox 比例风险回归模型突出显示，SIB 方法的调整后危险比（AdjHR）为 1.18（95%CI：0.67-2.09；p=0.560），尽管在第 24 个月之前的 AdjHR 为 0.95（95%CI：0.49-1.84；p=0.877）。
结论
与基于 SeqB 的治疗相比，基于 SIB 的 RT 为非转移性肛门癌患者提供了相似的临床结果。
Zotero 插件