Caravatta Luciana, Mantello Giovanna, Valvo Francesca, Franco Pierfrancesco, Gasparini Lucrezia, Rosa Consuelo, Slim Najla, Manfrida Stefania, De Felice Francesca, Gerardi Marianna A, Vagge Stefano, Krengli Marco, Palazzari Elisa, Osti Maria Falchetto, Gonnelli Alessandra, Catalano Gianpiero, Pittoni Patrizia, Ivaldi Giovani Battista, Galardi Alessandra, Lupattelli Marco, Rosetto Maria Elena, Niespolo Rita Marina, Guido Alessandra, Durante Oreste, Macchia Gabriella, Munoz Fernando, El Khouzai Badr, Lucido Maria Rosaria, Porreca Annamaria, Di Nicola Marta, Gambacorta Maria Antonietta, Donato Vittorio, Genovesi Domenico
Radiation Oncology Unit, "SS Annunziata" Hospital, "G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy.
Department of Oncology and Radiotherapy, Azienda Ospedaliero Universitaria Ospedali Riuniti, 60002 Ancona, Italy.
Cancers (Basel). 2021 Apr 15;13(8):1902. doi: 10.3390/cancers13081902.
A multi-institutional retrospective study was conducted to evaluate the pattern of care and clinical outcomes of anal cancer patients treated with intensity-modulated radiotherapy (IMRT) techniques. In a cohort of 987 patients, the clinical complete response (CR) rate (beyond 6 months) was 90.6%. The 3-year local control (LC) rate was 85.8% (95% CI: 84.4-87.2), and the 3-year colostomy-free survival (CFS) rate was 77.9% (95% CI: 76.1-79.8). Three-year progression-free survival (PFS) and overall survival (OS) rates were 80.2% and 88.1% (95% CI: 78.8-89.4) (95% CI: 78.5-81.9), respectively. Histological grade 3 and nodal involvement were associated with lower CR ( = 0.030 and = 0.004, respectively). A statistically significant association was found between advanced stage and nodal involvement, and LC, CFS, PFS, OS and event-free survival (EFS). Overall treatment time (OTT) ≥45 days showed a trend for a lower PFS ( = 0.050) and was significantly associated with lower EFS ( = 0.030) and histological grade 3 with a lower LC ( = 0.025). No statistically significant association was found between total dose, dose/fraction and/or boost modality and clinical outcomes. This analysis reports excellent clinical results and a mild toxicity profile, confirming IMRT techniques as standard of care for the curative treatment of anal cancer patients. Lymph node involvement and histological grade have been confirmed as the most important negative prognostic factors.
开展了一项多机构回顾性研究，以评估采用调强放疗（IMRT）技术治疗的肛管癌患者的治疗模式和临床结局。在987例患者队列中，临床完全缓解（CR）率（超过6个月）为90.6%。3年局部控制（LC）率为85.8%（95%CI：84.4 - 87.2），3年无结肠造口生存率（CFS）为77.9%（95%CI：76.1 - 79.8）。3年无进展生存率（PFS）和总生存率（OS）分别为80.2%和88.1%（95%CI：78.8 - 89.4）（95%CI：78.5 - 81.9）。组织学3级和淋巴结受累与较低的CR相关（分别为P = 0.030和P = 0.004）。在晚期与淋巴结受累以及LC、CFS、PFS、OS和无事件生存率（EFS）之间发现了具有统计学意义的关联。总治疗时间（OTT）≥45天显示出PFS较低的趋势（P = 0.050），并且与较低的EFS（P = 0.030）以及组织学3级与较低的LC（P = 0.025）显著相关。在总剂量、剂量/分次和/或加量方式与临床结局之间未发现具有统计学意义的关联。该分析报告了出色的临床结果和轻微的毒性特征，证实IMRT技术是肛管癌患者根治性治疗的标准治疗方法。淋巴结受累和组织学分级已被确认为最重要的不良预后因素。
