Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Germany.
Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.
Sci Rep. 2022 Nov 19;12(1):19914. doi: 10.1038/s41598-022-24362-8.
We compared our institutional experience with intensity-modulated radiotherapy (IMRT) and 3D-conformal radiotherapy (3D-RT) for definitive treatment of primary anal cancer. We performed a single-institution retrospective review of all patients with anal squamous cell carcinoma treated with definitive (chemo) radiotherapy with curative intent from 2004 through 2018. We assessed several prognostic factors in respect to relevant survival endpoints. In addition, acute toxicities were determined and compared between IMRT and 3D-RT patients. This study included 94 patients (58 IMRT, 36 3D-RT). Mean follow up for all patients, for IMRT and 3D-RT patients was 61 months (range 6-176), 46 months (range 6-118), and 85 months (range 6-176), respectively. 5-year overall survival (OS) was 86%, disease-free survival (DFS) was 72%, and colostomy-free survival (CFS) was 75% in the IMRT cohort. In the 3D-RT cohort, OS was 87%, DFS was 71%, and CFS was 81% (all p > 0.05). Male gender and Karnofsky Index (KI) were revealed as independent prognostic factors for 5-year OS (p = 0.017; p = 0.023). UICC stage was an independent prognostic factor for DFS and CFS (p = 0.023; p = 0.042). In addition, the pre-treatment leukocyte count was an independent prognostic factor for CFS (p = 0.042). Acute grade ≥ 3 toxicity was not significantly different between IMRT and 3D-RT patients, but the IMRT cohort had favorable outcomes. This study confirmed IMRT as the primary definitive treatment of anal cancer. With similar survival rates, IMRT had the potential to reduce acute toxicity by sparing organs at risk. Promising prognostic factors such as BMI, KI, and leucocyte and hemoglobin levels should be further investigated.
我们比较了我们机构在使用调强放疗（IMRT）和三维适形放疗（3D-RT）治疗原发性肛门癌的经验。我们对 2004 年至 2018 年期间接受根治性（化疗）放疗的所有肛门鳞癌患者进行了单机构回顾性研究。我们评估了几个与相关生存终点相关的预后因素。此外，我们还比较了 IMRT 和 3D-RT 患者之间的急性毒性。这项研究共纳入 94 例患者（58 例 IMRT，36 例 3D-RT）。所有患者、IMRT 患者和 3D-RT 患者的中位随访时间分别为 61 个月（范围 6-176）、46 个月（范围 6-118）和 85 个月（范围 6-176）。IMRT 组的 5 年总生存率（OS）为 86%，无病生存率（DFS）为 72%，无造口生存率（CFS）为 75%。3D-RT 组的 OS 为 87%，DFS 为 71%，CFS 为 81%（均 P>0.05）。男性和 Karnofsky 指数（KI）是 5 年 OS 的独立预后因素（P=0.017；P=0.023）。UICC 分期是 DFS 和 CFS 的独立预后因素（P=0.023；P=0.042）。此外，治疗前白细胞计数是 CFS 的独立预后因素（P=0.042）。IMRT 和 3D-RT 患者的急性 3 级及以上毒性无显著差异，但 IMRT 组的结局较好。这项研究证实了 IMRT 是肛门癌的主要根治性治疗方法。IMRT 通过保护危及器官，具有降低急性毒性的潜力，同时也能获得相似的生存率。BMI、KI、白细胞和血红蛋白水平等有前途的预后因素应进一步研究。
