Department of Radiotherapy and Oncology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Frankfurt Cancer Institute (FCI), Frankfurt, Germany.
Radiat Oncol. 2020 May 25;15(1):122. doi: 10.1186/s13014-020-01539-x.
Radiotherapy dose and target volume prescriptions for anal squamous cell carcinoma (ASCC) vary considerably in daily practice and guidelines, including those from NCCN, UK, Australasian, and ESMO. We conducted a pattern-of-care survey to assess the patient management in German speaking countries.
We developed an anonymous questionnaire comprising 18 questions on diagnosis and treatment of ASCC. The survey was sent to 361 DEGRO-associated institutions, including 41 university hospitals, 118 non-university institutions, and 202 private practices.
We received a total of 101 (28%) surveys, including 20 (19.8%) from university, 36 (35.6%) from non-university clinics, and 45 (44.6%) from private practices. A total of 28 (27.8%) institutions reported to treat more than 5 patients with early-stage ASCC and 42 (41.6%) institutions treat more than 5 patients with locoregionally-advanced ASCC per year. Biopsy of suspicious inguinal nodes was advocated in only 12 (11.8%) centers. Screening for human immunodeficiency virus (HIV) is done in 28 (27.7%). Intensity modulated radiotherapy or similar techniques are used in 97%. The elective lymph node dose ranged from 30.6 Gy to 52.8 Gy, whereas 87% prescribed 50.4-55. 8 Gy (range: 30.6 to 59.4 Gy) to the involved lymph nodes. The dose to gross disease of cT1 or cT2 ASCC ranged from 50 to ≥60 Gy. For cT3 or cT4 tumors the target dose ranged from 54 Gy to more than 60 Gy, with 76 (75.2%) institutions prescribing 59.4 Gy. The preferred concurrent chemotherapy regimen was 5-FU/Mitomycin C, whereas 6 (6%) prescribed Capecitabine/Mitomycin C. HIV-positive patients are treated with full-dose CRT in 87 (86.1%) institutions. First assessment for clinical response is reported to be performed at 4-6 weeks after completion of CRT in 2 (2%) institutions, at 6-8 weeks in 20 (19.8%), and 79 (78%) institutions wait up to 5 months.
We observed marked differences in radiotherapy doses and treatment technique in patients with ASCC, and also variable approaches for patients with HIV. These data underline the need for an consensus treatment guideline for ASCC.
在日常实践和指南中，放射治疗剂量和靶区体积的处方对于肛门鳞状细胞癌（ASCC）差异很大，包括 NCCN、英国、澳大拉西亚和 ESMO 指南。我们进行了一项治疗模式调查，以评估德国讲德语国家的患者管理情况。
我们开发了一个匿名问卷，其中包含 18 个关于 ASCC 诊断和治疗的问题。该调查被发送给 361 家与 DEGRO 相关的机构，包括 41 家大学医院、118 家非大学机构和 202 家私人诊所。
我们共收到 101 份（28%）调查问卷，其中 20 份来自大学，36 份来自非大学诊所，45 份来自私人诊所。共有 28 家（27.8%）机构报告每年治疗超过 5 例早期 ASCC 患者，42 家（41.6%）机构每年治疗超过 5 例局部晚期 ASCC 患者。只有 12 家（11.8%）中心主张对可疑腹股沟淋巴结进行活检。28 家（27.7%）机构进行人类免疫缺陷病毒（HIV）筛查。97%采用调强放疗或类似技术。选择性淋巴结剂量范围为 30.6Gy 至 52.8Gy，而 87%的机构（范围为 30.6 至 59.4Gy）对受累淋巴结处方 50.4-55.8Gy。对于 cT1 或 cT2 ASCC 的大体疾病，剂量范围为 50Gy 至≥60Gy。对于 cT3 或 cT4 肿瘤，靶剂量范围为 54Gy 至 60Gy 以上，76 家（75.2%）机构处方 59.4Gy。首选的同步化疗方案为 5-FU/丝裂霉素 C，而 6 家（6%）机构处方卡培他滨/丝裂霉素 C。87 家（86.1%）机构对 HIV 阳性患者采用全剂量 CRT 治疗。2 家（2%）机构在 CRT 完成后 4-6 周报告首次进行临床反应评估，20 家（19.8%）机构在 6-8 周进行评估，79 家（78%）机构等待长达 5 个月。
我们观察到肛门鳞状细胞癌患者的放射治疗剂量和治疗技术存在显著差异，同时也观察到 HIV 患者的治疗方法存在差异。这些数据强调了制定肛门鳞状细胞癌共识治疗指南的必要性。
