Oncology Department, University Hospitals of North Midlands, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK.
Cambridge University Hospitals, Hills Road, Cambridge, CB2 0QQ, UK.
J Gastrointest Cancer. 2023 Sep;54(3):867-872. doi: 10.1007/s12029-022-00866-4. Epub 2022 Oct 21.
Anal cancer is a rare form of gastrointestinal malignancy, and treatment is often confined to specialist centres. It has a high cure rate with non-surgical approach resulting in organ preservation. The current accepted schedule is chemo-radiotherapy (CRT) with 5-fluorouracil and mitomycin with radiotherapy doses between 50.4 and 53.2 Gray in 28 fractions.
This study included patients who had histological confirmation of squamous cell carcinoma and had completed the full CRT course for anal cancer between 2008 and 2018 in our centre. Data was collected retrospectively assessing demographics, staging, surgery, relapse, latest follow-up, date of death, CRT regimen and TNM stage. Outcome data and stoma reversal rate were analysed.
Overall, 87 patients were included in the study. At diagnosis 94.3% of patients had T2-T4 disease, and 44.8% had involvement of positive loco-regional lymph nodes. Overall survival (OS) probability at 1, 3 and 5 years were 98.8%, 87.4% and 83.7%, respectively. Results also revealed a statistically significant effect of time from diagnosis to the start of radiotherapy on OS (p = 0.039). Sixty-nine (79.3%) patients achieved complete remission at last follow-up. Twenty-one patients (24%) underwent surgery for a de-functioning stoma, and only five of these patients subsequently received stoma reversal surgery.
Our data reflects the efficacy of CRT as the primary modality of treatment in the management of anal squamous cell carcinoma with effective organ preservation and disease control. Early stoma reversal may also enhance quality of life.
肛门癌是一种罕见的胃肠道恶性肿瘤，其治疗通常限于专业中心。采用非手术方法，通过保留器官的方式进行化疗-放疗（CRT），可实现高治愈率。目前公认的方案是使用氟尿嘧啶和丝裂霉素的 CRT，放疗剂量为 50.4 至 53.2 Gray，分 28 次进行。
本研究纳入了 2008 年至 2018 年期间在我们中心完成完整 CRT 疗程的经组织学证实为鳞状细胞癌的患者。回顾性收集数据，评估人口统计学、分期、手术、复发、最新随访、死亡日期、CRT 方案和 TNM 分期。分析了结果数据和造口逆转率。
共有 87 例患者纳入本研究。在诊断时，94.3%的患者存在 T2-T4 期疾病，44.8%的患者存在局部区域淋巴结阳性受累。1、3 和 5 年的总生存率（OS）概率分别为 98.8%、87.4%和 83.7%。结果还显示，从诊断到开始放疗的时间对 OS 有统计学显著影响（p=0.039）。69 例（79.3%）患者在最后一次随访时达到完全缓解。21 例（24%）患者因造口功能障碍而行手术治疗，其中仅 5 例患者随后接受了造口逆转手术。
我们的数据反映了 CRT 作为肛门鳞状细胞癌治疗的主要方式的疗效，实现了有效的器官保留和疾病控制。早期的造口逆转也可能提高生活质量。
