剂量递增对肛门鳞癌结肠造口术无生存和治疗结果的影响。
Impact of dose escalation on colostomy-free survival and treatment outcome in squamous cell anal carcinoma.
机构信息
Department of Radiation Oncology, University Hospital Muenster, 48149, Muenster, Germany.
Department for General, Visceral and Transplant Surgery, University Hospital Muenster, 48149, Muenster, Germany.
出版信息
Strahlenther Onkol. 2023 Aug;199(8):749-760. doi: 10.1007/s00066-023-02056-y. Epub 2023 Mar 2.
PURPOSE
Primary radiochemotherapy (RCT) constitutes the standard of care for early- and advanced-stage anal carcinoma. This retrospective study investigates the impact of dose escalation on colostomy-free survival (CFS), overall survival (OS), locoregional control (LRC), progression-free survival (PFS), and acute and late toxicities in patients with squamous cell anal cancer.
METHODS
Considered were the outcomes of 87 patients with anal cancer treated with radiation/RCT between May 2004 and January 2020 at our institution. Toxicities were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE version 5.0).
RESULTS
The 87 patients received treatment with a median boost of 63 Gy to the primary tumor. With a median follow-up of 32 months, the 3‑year CFS, OS, LRC, and PFS were 79.5%, 71.4%, 83.9%, and 78.5%, respectively. Tumor relapse occurred in 13 patients (14.9%). Dose escalation to > 63 Gy (maximum 66.6 Gy) to the primary tumor in 38/87 patients revealed a nonsignificant trend for improved 3‑year CFS (82.4% vs. 97%, P = 0.092), a significantly improved CFS for T2/T3 tumors (72.6% vs. 100%, P = 0.008), and a significantly improved 3‑year PFS for T1/T2 tumors (76.7% vs. 100%, P = 0.035). While acute toxicities did not differ, dose escalation > 63 Gy led to a higher rate of chronic skin toxicities (43.8% vs. 69%, P = 0.042). Treatment with intensity-modulated radiotherapy (IMRT) showed a significant improvement in 3‑year OS (75.4% vs. 53.8%, P = 0.048). In multivariate analysis, significant improvements for T1/T2 tumors (CFS, OS, LRC, PFS), G1/2 tumors (PFS), and IMRT (OS) were shown. The nonsignificant trend for CFS improvement with dose escalation > 63 Gy was also apparent in multivariate analysis (P = 0.067).
CONCLUSION
Dose escalation > 63 Gy (maximum 66.6 Gy) may improve CFS and PFS for certain subgroups, with a concomitant increase in chronic skin toxicities. Modern IMRT seems to be associated with an improvement in OS.
目的
原发放化疗（RCT）是早期和晚期肛门癌的标准治疗方法。本回顾性研究旨在探讨剂量递增对无造口术生存（CFS）、总生存（OS）、局部区域控制（LRC）、无进展生存（PFS）以及接受放射治疗的肛门鳞状细胞癌患者急性和迟发性毒性的影响。
方法
分析了 2004 年 5 月至 2020 年 1 月期间在我院接受放射治疗/RCT 的 87 例肛门癌患者的治疗结果。根据常见不良事件术语标准（CTCAE 第 5.0 版）评估毒性。
结果
87 例患者接受中位剂量为 63 Gy 的原发肿瘤推量治疗。中位随访 32 个月，3 年 CFS、OS、LRC 和 PFS 分别为 79.5%、71.4%、83.9%和 78.5%。13 例患者（14.9%）发生肿瘤复发。在 38/87 例患者中，原发肿瘤剂量递增至>63 Gy（最大 66.6 Gy）显示 3 年 CFS（82.4% vs. 97%，P=0.092）、T2/T3 肿瘤的 CFS（72.6% vs. 100%，P=0.008）以及 T1/T2 肿瘤的 3 年 PFS（76.7% vs. 100%，P=0.035）显著改善。虽然急性毒性无差异，但剂量递增>63 Gy 导致慢性皮肤毒性发生率更高（43.8% vs. 69%，P=0.042）。调强放疗（IMRT）的应用显著改善了 3 年 OS（75.4% vs. 53.8%，P=0.048）。多因素分析显示，T1/T2 肿瘤（CFS、OS、LRC、PFS）、G1/2 肿瘤（PFS）和 IMRT（OS）的改善具有统计学意义。多因素分析中也显示出剂量递增>63 Gy 与 CFS 改善的显著趋势（P=0.067）。
结论
剂量递增>63 Gy（最大 66.6 Gy）可能会改善某些亚组的 CFS 和 PFS，但会增加慢性皮肤毒性。现代调强放疗似乎与 OS 的改善有关。
Zotero 插件