University of Leeds, Leeds Cancer Centre, St. James's University Hospital, Leeds, UK.
The Royal College of Radiologists, London, UK.
Eur J Cancer. 2020 Mar;128:7-16. doi: 10.1016/j.ejca.2019.12.022. Epub 2020 Mar 5.
Concurrent chemoradiotherapy is the standard treatment for anal cancer. Following national UK implementation of intensity-modulated radiotherapy (IMRT), this prospective, national cohort evaluates the one-year oncological outcomes and patient-reported toxicity outcomes (PRO) after treatment.
A national cohort of UK cancer centers implementing IMRT was carried out between February to July 2015. Cancer centers provided data on oncological outcomes, including survival, and disease and colostomy status at one-year. EORTC-QLQ core (C30) and colorectal (CR29) questionnaires were completed at baseline and one-year followup. The PRO scores at baseline and one year were compared.
40 UK Cancer Centers returned data with a total of 187 patients included in the analysis. 92% received mitomycin with 5-fluorouracil or capecitabine. One-year overall survival was 94%; 84% were disease-free and 86% colostomy-free at one-year followup. At one year, PRO results found significant improvements in buttock pain, blood and mucus in stools, pain, constipation, appetite loss, and health anxiety compared to baseline. No significant deteriorations were reported in diarrhea, bowel frequency, and flatulence. Urinary symptom scores were low at one year. Moderate impotence symptoms at baseline remained at one year, and a moderate deterioration in dyspareunia reported.
With national anal cancer IMRT implementation, at this early pre-defined time point, one-year oncological outcomes were reassuring and resulted in good disease-related symptom control. one-year symptomatic complications following CRT for anal cancer using IMRT techniques appear to be relatively mild. These PRO results provide a basis to benchmark future studies.
同步放化疗是肛门癌的标准治疗方法。在英国全国范围内实施强度调制放疗（IMRT）后，本前瞻性全国队列评估了治疗后一年的肿瘤学结果和患者报告的毒性结果（PRO）。
2015 年 2 月至 7 月期间，英国癌症中心开展了一项全国性的 IMRT 实施队列研究。癌症中心提供了肿瘤学结果的数据，包括生存情况以及一年时的疾病和结肠造口状态。EORTC-QLQ 核心（C30）和结直肠（CR29）问卷在基线和一年随访时完成。比较了基线和一年时的 PRO 评分。
40 家英国癌症中心返回了数据，共有 187 名患者纳入分析。92%的患者接受了丝裂霉素联合氟尿嘧啶或卡培他滨治疗。一年总生存率为 94%；84%的患者在一年随访时无疾病，86%的患者无结肠造口。一年时，PRO 结果显示，与基线相比，臀部疼痛、粪便中的血液和黏液、疼痛、便秘、食欲下降和健康焦虑等方面均有显著改善。腹泻、排便频率和肠胃气胀没有显著恶化。一年时的尿症状评分较低。基线时中度勃起功能障碍症状持续存在，且性交困难报告中度恶化。
随着全国范围内肛门癌 IMRT 的实施，在这个预先定义的早期时间点，一年的肿瘤学结果令人放心，并且导致了良好的疾病相关症状控制。使用 IMRT 技术进行 CRT 治疗肛门癌后的一年时的症状性并发症似乎相对较轻。这些 PRO 结果为未来的研究提供了基准。
