Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.
University of Pennsylvania Radiation Oncology Residency Program, 3400 Civic Center Boulevard, Concourse Level, Philadelphia, PA, 19104, USA.
J Gastrointest Cancer. 2021 Mar;52(1):229-236. doi: 10.1007/s12029-020-00393-0.
Definitive chemoradiotherapy represents a standard of care treatment for localized anal cancer. National Comprehensive Cancer Network guidelines recommend radiotherapy (RT) doses of ≥ 45 Gy and escalation to 50.4-59 Gy for advanced disease. Per RTOG 0529, 50.4 Gy was prescribed for early-stage disease (cT1-2N0), and 54 Gy for locally advanced cancers (cT3-T4 and/or node positive). We assessed patterns of care and overall survival (OS) with respect to the RT dose.
The National Cancer Database identified patients with non-metastatic anal squamous cell carcinoma from 2004 to 2015 treated with chemoradiotherapy. Patients were stratified by RT dose: 40-< 45, 45-< 50, 50-54, and > 54-60 Gy. Crude and adjusted hazard ratios (HR) were computed using Cox regression modeling.
A total of 10,524 patients were identified with a median follow-up of 40.7 months. The most commonly prescribed RT dose was 54 Gy. On multivariate analysis, RT doses of 40-< 45 Gy were associated with worse OS vs. 50-54 Gy (HR 1.68 [1.40-2.03], P < 0.0001). There was no significant difference in OS for patients who received 45-< 50 or > 54-60 Gy compared with 50-54 Gy. For early-stage disease, there was no significant association between RT dose and OS. For locally advanced disease, 45-< 54 Gy was associated with worse survival vs. 54 Gy (HR 1.18 [1.04-1.34], P = 0.009), but no significant difference was detected comparing > 54-60 Gy vs. 54 Gy (HR 1.08 [0.97-1.22], P = 0.166).
For patients with localized anal cancer, RT doses of ≥ 45 Gy were associated with improved OS. For locally advanced disease, 54 Gy but not > 54 Gy was associated with improved OS.
根治性放化疗是局部肛门癌的标准治疗方法。美国国家综合癌症网络指南建议对晚期疾病给予 45Gy 以上的放疗剂量，并将剂量提升至 50.4-59Gy。根据 RTOG 0529 试验，早期疾病（cT1-2N0）给予 50.4Gy，局部进展期疾病（cT3-T4 和/或淋巴结阳性）给予 54Gy。我们评估了放疗剂量与治疗模式和总生存（OS）之间的关系。
国家癌症数据库（National Cancer Database）从 2004 年至 2015 年期间，收集接受放化疗的非转移性肛门鳞癌患者资料。根据放疗剂量分为 40-<45Gy、45-<50Gy、50-54Gy 和 >54-60Gy 组。使用 Cox 回归模型计算粗死亡率和调整后的危险比（HR）。
共纳入 10524 例患者，中位随访时间为 40.7 个月。最常采用的放疗剂量为 54Gy。多因素分析显示，与 50-54Gy 相比，40-<45Gy 组的 OS 更差（HR 1.68 [1.40-2.03]，P<0.0001）。45-<50Gy 与 >54-60Gy 组的 OS 无显著差异。对于早期疾病，放疗剂量与 OS 无显著相关性。对于局部进展期疾病，45-<54Gy 组的 OS 差于 54Gy 组（HR 1.18 [1.04-1.34]，P=0.009），但 >54-60Gy 组与 54Gy 组之间无显著差异（HR 1.08 [0.97-1.22]，P=0.166）。
对于局部肛门癌患者，≥45Gy 的放疗剂量与 OS 改善相关。对于局部进展期疾病，54Gy 而非 >54Gy 与 OS 改善相关。
