Cummings B J
Gastroenterol Clin North Am. 1987 Mar;16(1):125-42.
Treatment with a combination of radiation therapy and chemotherapy currently allows about 80 per cent of patients with epidermoid carcinomas of the anal canal to retain anorectal function, with about a 70 per cent likelihood of cure at 5 years. In these programs, radical surgery is reserved for the management of residual cancer or of radiation- or chemotherapy-induced anorectal toxicity. Several different schedules of combined modality therapy are in use, but an important common element in most schedules appears to be the concurrent administration of radiation and 5-fluorouracil. The improvement in local control rates with combined radiation and chemotherapy, as compared to most series treated by either radical radiation or radical surgery, has not been matched by a marked improvement in survival rates, and the risk of distant metastases does not appear to have been altered by these combinations. The success of the combinations in improving local control has allowed the indications for local excision to be defined more narrowly, and should reduce the risks of local recurrence associated with conservative surgery.
目前，放射治疗和化疗相结合的治疗方法使约80%的肛管表皮样癌患者能够保留肛门直肠功能，5年治愈的可能性约为70%。在这些治疗方案中，根治性手术用于治疗残留癌或放疗或化疗引起的肛门直肠毒性。目前正在使用几种不同的综合治疗方案，但大多数方案中的一个重要共同要素似乎是同时给予放疗和5-氟尿嘧啶。与大多数单纯根治性放疗或根治性手术治疗的系列相比，放疗和化疗联合应用使局部控制率有所提高，但生存率并未显著提高，而且这些联合治疗似乎并未改变远处转移的风险。联合治疗在改善局部控制方面的成功使得局部切除的适应证得以更严格地界定，并应降低与保守手术相关的局部复发风险。
