Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), partner site, Frankfurt a. M., Germany.
Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), partner site, Frankfurt a. M., Germany.
Radiother Oncol. 2020 Aug;149:168-173. doi: 10.1016/j.radonc.2020.05.016. Epub 2020 May 14.
Previous studies have shown that acute organ toxicity to (chemo)radiotherapy (CRT) is associated with improved oncological outcome in various tumor types. The aim of the present study was to investigate the relationship of toxicity with clinical outcome in a large cohort of 223 patients with anal squamous cell carcinoma (ASCC) treated with standard CRT.
We identified 223 patients treated with definitive CRT for non-metastasized ASCC. Acute organ toxicities were scored weekly as part of the clinical routine. Dermatitis, diarrhea, proctitis and cystitis of ≥ grade 3 was defined as a high-grade acute organ toxicity (HGAOT). High-grade acute hematologic toxicity (HGAHT) defined as a hematologic toxicity ≥ grade 3 was assessed as well.
In total 107 (48%) patients experienced at least one HGAOT during CRT with the most common being dermatitis (40% ≥ grade 3). No correlation of HGAOT was noted with either tumor stage, gender, or radiotherapy technique. With a median-follow-up of 46 months, patients with HGAOT had significantly better disease-free survival (DFS, p = 0.008). In contrast, HGAHT did not impact DFS (p = 0.30). Multivariate analysis revealed that HGAOT was an independent prognostic factor for DFS (HR 0.47 95% CI: 0.27-0.83, p = 0.01) in addition to N-stage (HR 3.06 95% CI: 1.70-5.49, p < 0.001) and gender (HR 0.47 95% CI: 0.26-0.84, p = 0.01).
To the best of our knowledge, this is the largest study in ASCC to demonstrate the association of HGAOT with better oncological outcome after standard CRT. Further studies are needed to elucidate the possible underlying mechanisms behind this intriguing clinical phenomenon.
先前的研究表明，急性器官毒性与各种肿瘤类型的（放）化疗（CRT）的改善肿瘤预后有关。本研究的目的是在接受标准 CRT 治疗的 223 例肛门鳞癌（ASCC）患者的大队列中，研究毒性与临床结局的关系。
我们确定了 223 例接受根治性 CRT 治疗非转移性 ASCC 的患者。每周作为临床常规的一部分对急性器官毒性进行评分。≥3 级的皮炎、腹泻、直肠炎和膀胱炎定义为高等级急性器官毒性（HGAOT）。同样评估了定义为≥3 级的血液学毒性的高等级急性血液学毒性（HGAHT）。
共有 107 例（48%）患者在 CRT 期间经历了至少一次 HGAOT，最常见的是皮炎（40%≥3 级）。HGAOT 与肿瘤分期、性别或放疗技术均无相关性。中位随访 46 个月后，HGAOT 患者的无病生存率（DFS）显著更好（p=0.008）。相反，HGAHT 对 DFS 没有影响（p=0.30）。多变量分析显示，HGAOT 是 DFS 的独立预后因素（HR 0.47 95%CI：0.27-0.83，p=0.01），此外还有 N 分期（HR 3.06 95%CI：1.70-5.49，p<0.001）和性别（HR 0.47 95%CI：0.26-0.84，p=0.01）。
据我们所知，这是 ASCC 中最大的研究，证明了 HGAOT 与标准 CRT 后肿瘤学结局改善有关。需要进一步的研究来阐明这一有趣的临床现象背后的潜在机制。
