Department of Radiation Oncology, University of Health Sciences, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
Department of Radiation Oncology, University of Health Sciences, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
Clin Colorectal Cancer. 2023 Sep;22(3):318-326. doi: 10.1016/j.clcc.2023.05.004. Epub 2023 May 22.
This study aimed to determine treatment outcomes and factors affecting prognosis in patients diagnosed with anal canal cancer who received radical radiotherapy (RT) or radiotherapy combined with chemotherapy (CT-RT) in radiation oncology centers in Turkey and compare the results with literature.
The study included 193 patients with anal canal cancer reported between 1995 and 2019, of which 162 had complete data. The study was conducted in 11 radiation oncology centers, and a joint database was shared among them. Patients received radiotherapy doses of 45 Gy to 60 Gy. Data analysis was done using SPSS for Windows version 20.
Median follow-up was 48.51 months (2-214). All patients received radiotherapy, and 140 (86.4%) received concurrent chemotherapy. Radiotherapy doses of 50.4 Gy to 60 Gy were administered to 74 patients (45.7%) using 2-dimensional-3-dimensional (2D-3D) conformal therapy and 70 patients (43.2%) using intensity modulated radiotherapy technique (IMRT). Acute phase hematologic toxicity was observed in 62 patients (38.3%), and nonhematologic toxicity in 123 patients (75.9%). The 5-year overall survival (OS) rate was 75.1% and disease-specific survival (DSS) rate was 76.4%. OS without colostomy was achieved in 79,8 % at 5 years, and complete response in 112 patients (69.1%). OS rate was significantly higher in 142 patients with positive response (P < .000) and 112 with complete response (P < .000). Anemia (P < .002), local progression, and systemic progression (P < .000) resulted in lower OS (P < .002). In univariate analysis, factors affecting OS rate were: gender, age, stage, lymph node status, T stage, RT treatment duration, and treatment planning with PET fusion, which were found to be statistically significant. Completing radiotherapy in less than 45 days, concurrent chemotherapy, and continued administration of mitomycin and 5 FU as chemotherapy had a significant positive effect on overall survival. OS rate was higher in patients receiving RT dose of 58 Gy or less and undergoing IMRT planning in radiotherapy. IMRT was associated with lower acute and late side effects.
Radiochemotherapy is the primary treatment for anal canal cancer and advanced radiotherapy techniques may increase survival by reducing side effects and improving treatment continuation. Higher treatment doses require further investigation. The efficacy of treatment can be improved by including patients treated with modern radiotherapy techniques in multicenter prospective studies using new and more effective chemotherapy and immunotherapy agents.
本研究旨在确定在土耳其的放射肿瘤学中心接受根治性放疗（RT）或放疗联合化疗（CT-RT）的肛管癌患者的治疗结果和影响预后的因素，并将结果与文献进行比较。
本研究纳入了 1995 年至 2019 年间报告的 193 例肛管癌患者，其中 162 例具有完整数据。该研究在 11 个放射肿瘤学中心进行，并在这些中心之间共享联合数据库。患者接受 45 Gy 至 60 Gy 的放疗剂量。数据分析使用 Windows 版本 20 的 SPSS 进行。
中位随访时间为 48.51 个月（2-214）。所有患者均接受放疗，140 例（86.4%）接受同步化疗。74 例患者（45.7%）接受二维三维（2D-3D）适形放疗，70 例患者（43.2%）接受调强放疗技术（IMRT），给予 50.4 Gy 至 60 Gy 的放疗剂量。62 例（38.3%）出现急性血液学毒性，123 例（75.9%）出现非血液学毒性。5 年总生存率（OS）为 75.1%，疾病特异性生存率（DSS）为 76.4%。5 年内无造口术的 OS 为 79.8%，112 例完全缓解（69.1%）。142 例有阳性反应（P<0.000）和 112 例完全缓解（P<0.000）的患者 OS 率显著更高。贫血（P<0.002）、局部进展和全身进展（P<0.000）导致 OS 降低（P<0.002）。单因素分析显示，影响 OS 率的因素有：性别、年龄、分期、淋巴结状态、T 分期、RT 治疗持续时间以及 PET 融合治疗计划，这些因素具有统计学意义。在 45 天内完成放疗、同步化疗以及继续给予丝裂霉素和 5 FU 作为化疗，对总生存率有显著的积极影响。接受 58 Gy 或更低剂量 RT 并接受 IMRT 计划的患者 OS 率更高。IMRT 与较低的急性和迟发性副作用相关。
放化疗是肛管癌的主要治疗方法，先进的放疗技术可能通过降低副作用和提高治疗的连续性来提高生存率。更高的治疗剂量需要进一步研究。通过在多中心前瞻性研究中纳入接受现代放疗技术治疗的患者，并使用新的、更有效的化疗和免疫治疗药物，可以提高治疗效果。
