Department of Radiotherapy and Oncology, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
German Cancer Research Center (DKFZ), Heidelberg, Germany.
Strahlenther Onkol. 2019 May;195(5):369-373. doi: 10.1007/s00066-019-01444-7. Epub 2019 Apr 1.
Definitive chemoradiotherapy (CRT) is the standard treatment for anal squamous cell carcinoma (ASCC). Data regarding treatment outcome according to TNM classification is scarce. Here, we review data of randomized trials and retrospective cohorts suggesting a poor 3‑year disease-free survival (DFS; or progression-free survival, PFS) of approximately 60%, or even lower, in patients with locally advanced T3-4 and/or N+ disease, while patients with T1-2N0 ASCC have 3‑year DFS/PFS rates exceeding 80%. These results are in line with our data in a cohort of 210 patients with ASCC treated with definitive 5‑fluorouracil/mitomycin C‑based CRT to a total dose of 50.4 Gy plus a boost of 3.6-10.8 Gy. The implications of these findings and the current trials testing radiotherapy dose escalation/de-escalation strategies are reported. Finally, we will discuss the strong rationale for testing immune checkpoint blockade (ICB) with CRT in clinical trials to improve results, especially in patients with advanced ASCC.
根治性放化疗（CRT）是肛门鳞状细胞癌（ASCC）的标准治疗方法。根据 TNM 分类，关于治疗结果的数据很少。在这里，我们回顾了一些随机试验和回顾性队列的数据，这些数据表明，局部晚期 T3-4 和/或 N+ 疾病患者的 3 年无疾病生存率（DFS；或无进展生存率，PFS）约为 60%，甚至更低，而 T1-2N0 ASCC 患者的 3 年 DFS/PFS 率超过 80%。这些结果与我们在 210 例接受根治性 5-氟尿嘧啶/丝裂霉素 C 为基础的 CRT 治疗的 ASCC 患者队列中的数据一致，总剂量为 50.4Gy，加量 3.6-10.8Gy。报告了这些发现的意义以及目前正在测试放疗剂量递增/递减策略的试验。最后，我们将讨论在临床试验中用 CRT 联合免疫检查点阻断（ICB）进行测试的强有力理由，以提高治疗效果，特别是在晚期 ASCC 患者中。
