Touboul E, Schlienger M, Buffat L, Ozsahin M, Belkacemi Y, Pene F, Balosso J, Lefkopoulos D, Parc R, Tiret E
Services de Cancérologie-Radiothérapie A, Hôpital Tenon, Paris, France.
Cancer. 1995 Feb 1;75(3):786-93. doi: 10.1002/1097-0142(19950201)75:3<786::aid-cncr2820750307>3.0.co;2-3.
The role of radiotherapy alone in the sterilization of anal canal epidermoid carcinomas of 5 cm or more remains to be assessed. Thus, the outcomes of patients treated with radiotherapy alone (RT) versus those treated with preoperative radiotherapy and surgery (RS) were compared retrospectively.
Between 1972 and 1990, 185 patients were treated with curative intent either with RT alone (n = 147) or with RS (n = 38). The Mean tumor length was 6.18 +/- 1.14 cm and was significantly longer in the RS group (6.55 +/- 1.29 cm) than in the RT group (6.08 +/- 1.08 cm) (P = 0.02). The median follow-up was 77 +/- 57 months and 93 +/- 60 months (P = 0.23) for the RT and RS groups, respectively. For the RT group, the first course of radiotherapy was 40 to 45 Gy in the pelvis for 4 to 5 weeks; after a rest of 4 to 6 weeks, radiotherapy was boosted an additional 15 to 20 Gy for 2 weeks. The RS patients received 40 to 45 Gy in the pelvis for 4 to 5 weeks, then received surgery after a median period of 54 days.
The overall 10-year cancer specific survival rates were 58% in the RT group and 66% in the RS group (P = 0.48). The T-stage 10-year cancer specific survival rates were 68% in the RT group and 67% in the RS group for T2 tumors (P = 0.96); 57% in the RT group and 53% in the RS group for T3 tumors (P = 0.85); and 42% in the RT group and 40% in the RS group for T4 tumors (P = 0.05). In the RS group, the local control rate was 75% (3/4) for T2 tumors; 74% (17/23) for T3 tumors; and 82% (9/11) for T4 tumors. In the RT group, the local control rate was 77% (34/44) for T2 tumors; 70% (58/82) for T3 tumors; and 60% (12/20) for T4 tumors. In the RT group, the anal conservation rate was 61% (27/44) for T2 tumors, 59% (48/82) for T3 tumors, and 55% (11/20) for T4 tumors. Local tumoral control and a functioning anus were present in 72 out of 147 (49%) patients [52% (23/44) for T2 patients, 52% (43/82) for T3 tumors, and 30% (6/20) for T4 patients]. In the RS group, the grade 3 complication rate was 9% (13/146) and in the RS group, 5% (2/38).
For patients with T4 tumors, preoperative radiotherapy and surgery seemed to be better in terms of survival and local tumor control rate, but the difference was not significant probably because the number of patients in the RS group was small. For these large tumors, the treatment should probably be more aggressive, combining chemotherapy and radiation therapy, but the increase of local control in relation with the addition of cytotoxic chemotherapy to irradiation is not proved.
单纯放疗在肛管表皮样癌（肿瘤直径5cm及以上）根治中的作用仍有待评估。因此，对单纯放疗（RT）与术前放疗加手术（RS）治疗的患者结局进行了回顾性比较。
1972年至1990年间，185例患者接受了根治性治疗，其中单纯放疗（n = 147）或术前放疗加手术（n = 38）。平均肿瘤长度为6.18±1.14cm，RS组（6.55±1.29cm）明显长于RT组（6.08±1.08cm）（P = 0.02）。RT组和RS组的中位随访时间分别为77±57个月和93±60个月（P = 0.23）。对于RT组，第一疗程放疗为盆腔40至45Gy，持续4至5周；休息4至6周后，再追加放疗15至20Gy，持续2周。RS组患者盆腔放疗40至45Gy，持续4至5周，然后在中位时间54天后接受手术。
RT组10年总体癌症特异性生存率为58%，RS组为66%（P = 0.48）。T2期肿瘤，RT组10年癌症特异性生存率为68%，RS组为67%（P = 0.96）；T3期肿瘤，RT组为57%，RS组为53%（P = 0.85）；T4期肿瘤，RT组为42%，RS组为40%（P = 0.05）。在RS组中，T2期肿瘤局部控制率为75%（3/4）；T3期肿瘤为74%（17/23）；T4期肿瘤为82%（9/11）。在RT组中，T2期肿瘤局部控制率为77%（34/44）；T3期肿瘤为70%（58/82）；T4期肿瘤为60%（12/20）。在RT组中，T2期肿瘤肛门保留率为61%（27/44），T3期肿瘤为59%（48/82），T4期肿瘤为55%（11/20）。147例（49%）患者中，72例实现了局部肿瘤控制且肛门功能正常[T2期患者为52%（23/44），T3期肿瘤为52%（43/82），T4期患者为30%（6/20）]。RS组3/4级并发症发生率为9%（13/146），RT组为5%（2/38）。
对于T4期肿瘤患者，术前放疗加手术在生存率和局部肿瘤控制率方面似乎更好，但差异可能不显著，因为RS组患者数量较少。对于这些大肿瘤，治疗可能应更积极，联合化疗和放疗，但尚无证据表明在放疗基础上加用细胞毒性化疗能提高局部控制率。
