Departments of Radiation Oncology.
GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
Am J Clin Oncol. 2020 May;43(5):319-324. doi: 10.1097/COC.0000000000000673.
US health care is increasingly defined by over expenditure and inefficiency. Optimizing patient follow-up is critical, especially in cancers treated with high control rates. To optimize patient care, this study assessed time to disease recurrence or toxicity in patients with anal carcinoma.
In total, 140 patients with biopsy-proven, nonmetastatic anal carcinoma, treated with chemoradiation utilizing intensity-modulated radiation therapy, were identified from our institutional database. This retrospective study evaluated local recurrence (LR), distant metastasis (DM), overall survival (OS), and late ≥grade 3 toxicity (LG3T). Patients were followed posttreatment every 3 months for 2 years, every 6 months in years 3 to 5, then yearly thereafter per NCCN recommendations.
The median age and follow-up was 58 years and 27 months, respectively. Patients were categorized into high (n=61; 44%) and low (n=77; 55%) risk groups based on stage. The 2-year LC, DMFS, and OS were 93%, 94%, and 89% and 5-year LC, DMFS, OS were 92%, 87%, and 85%, respectively. Overall, there were 29 events (9 LR, 11 DM, and 9 LG3T), with 62% of events occurring within year 1 and 79% within 2 years. Stratified by event type, at 2 years 89% of LR, 64% of DM, and 89% LG3T were identified. At the remaining follow-up points, the event incidence rate was 1.3%.
With the majority of recurrences/toxicities occurring within the first 2 years, a reduction in follow-up during years 3 to 5 may provide adequate surveillance. Revisions of the current recommendations could maximize resources while improving patient quality of life.
美国的医疗保健越来越受到过度支出和效率低下的影响。优化患者随访至关重要，尤其是在高控制率治疗的癌症中。为了优化患者护理，本研究评估了肛门癌患者的疾病复发或毒性的时间。
从我们的机构数据库中总共确定了 140 名经活检证实、无转移性肛门癌患者，这些患者接受了利用强度调制放射治疗的放化疗。这项回顾性研究评估了局部复发（LR）、远处转移（DM）、总生存（OS）和晚期≥3 级毒性（LG3T）。根据 NCCN 建议，患者在治疗后每 3 个月随访一次，持续 2 年，第 3 至 5 年每 6 个月随访一次，此后每年随访一次。
中位年龄和随访时间分别为 58 岁和 27 个月。根据分期，患者被分为高（n=61；44%）和低（n=77；55%）风险组。2 年的 LC、DMFS 和 OS 分别为 93%、94%和 89%，5 年的 LC、DMFS 和 OS 分别为 92%、87%和 85%。总体而言，有 29 例事件（9 例 LR、11 例 DM 和 9 例 LG3T），62%的事件发生在第 1 年内，79%发生在第 2 年内。按事件类型分层，在第 2 年，LR 为 89%，DM 为 64%，LG3T 为 89%。在其余随访点，事件发生率为 1.3%。
由于大多数复发/毒性发生在第 1 至 2 年内，因此在第 3 至 5 年内减少随访可能提供足够的监测。对现行建议的修订可以最大限度地利用资源，同时提高患者的生活质量。
