Roth O'Brien Diana A, Hristidis Vasilis C, Chakrani Zakaria, McCann Patrick, Damato Antonio, Williams Vonetta, Cote Nicolas, Reyngold Marsha, Rosen Roni, Connell Louise, Pappou Emmanouil, Hajj Carla, Paty Philip B, Horvat Natally, Pernicka Jennifer S Golia, Fiasconaro Megan, Shia Jinru, Lisanti Jeanine, Wu Abraham J, Gollub Marc J, Zhang Zhigang, Yaeger Rona, Zinovoy Melissa, Weiser Martin R, Saltz Len, Cuaron John, Boe Lillian, Cercek Andrea, Garcia-Aguilar Julio, Smith J Joshua, Crane Christopher H, Romesser Paul B
Department of Radiation Oncology, Colorectal and Anal Cancer Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
Int J Radiat Oncol Biol Phys. 2025 Mar 15;121(4):951-962. doi: 10.1016/j.ijrobp.2024.10.007. Epub 2024 Nov 12.
Patterns of failure and salvage therapy options for patients with anal squamous cell carcinoma (ASCC) who recur after definitive-intent intensity-modulated radiation therapy (IMRT) with concurrent chemotherapy are not well described.
We identified consecutive patients with ASCC treated with definitive-intent IMRT between July 2005 and December 2019. Relevant patient and tumor parameters, disease outcomes (locoregional failure [LRF], distant failure, progression-free survival, colostomy-free survival, and overall survival [OS]), patterns of failure, and salvage therapies were collected. Failures were analyzed using competing risk methods, whereas survival endpoints were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were performed. Landmark analyses were conducted by considering whether patients had LRF within 12 months of completing IMRT.
A total of 375 patients were identified with a median follow-up of 6 years. Stage breakdown was 15%, 23%, and 62% for the American Joint Committee on Cancer stages 0 to I, II, and III, respectively. Six-year rates of LRF, distant failure, progression-free survival, colostomy-free survival, and OS were 12%, 13%, 73%, 76%, and 80%, respectively. Disease recurred in 74 patients. Among the 45 patients with LRF, 39 (87%) failed within the anorectum, with 25 anal canal, 6 anal margin, and 8 rectal recurrences. Only 4 (9%) patients had isolated nodal failure. Patients experiencing LRF had worse 6-year OS than patients without LRF (44% vs 86%, P < .0001). Approximately 30% of patients who underwent salvage therapy were alive to 10 years after recurrence, compared with none of the patients who were managed with chemotherapy alone or the best supportive care.
This large ASCC cohort managed with definitive-intent IMRT demonstrated excellent rates of locoregional control and survival. Isolated regional nodal failures were uncommon, whereas the majority of LRFs occurred within the anorectum, despite dose escalation by tumor stage. We observed poor outcomes for patients experiencing locoregional disease recurrence, even after aggressive salvage treatment.
对于接受根治性调强放射治疗（IMRT）联合同步化疗后复发的肛管鳞状细胞癌（ASCC）患者，其失败模式和挽救治疗方案尚未得到充分描述。
我们纳入了2005年7月至2019年12月期间接受根治性IMRT治疗的连续性ASCC患者。收集相关的患者和肿瘤参数、疾病结局（局部区域失败[LRF]、远处失败、无进展生存期、无结肠造口生存期和总生存期[OS]）、失败模式和挽救治疗方法。使用竞争风险方法分析失败情况，而生存终点则使用Kaplan-Meier方法进行估计。进行单因素和多因素分析。通过考虑患者在完成IMRT后12个月内是否发生LRF来进行标志性分析。
共纳入375例患者，中位随访时间为6年。美国癌症联合委员会0至I期、II期和III期的分期分布分别为15%、23%和62%。LRF、远处失败、无进展生存期、无结肠造口生存期和OS的6年发生率分别为12%、13%、73%、76%和80%。74例患者疾病复发。在45例发生LRF的患者中，39例（87%）在肛管直肠内失败，其中25例为肛管复发，6例为肛缘复发，8例为直肠复发。仅有4例（9%）患者出现孤立性淋巴结失败。发生LRF的患者6年OS比未发生LRF的患者更差（44%对86%，P <.0001）。接受挽救治疗的患者中约30%在复发后存活至10年，而仅接受化疗或最佳支持治疗的患者无一存活至10年。
这个接受根治性IMRT治疗的大型ASCC队列显示出优异的局部区域控制率和生存率。孤立性区域淋巴结失败并不常见，而尽管根据肿瘤分期增加了剂量，但大多数LRF仍发生在肛管直肠内。我们观察到，即使经过积极的挽救治疗，局部区域疾病复发的患者结局仍较差。
