Cummings B J, Keane T J, O'Sullivan B, Wong C S, Catton C N
Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ont., Canada.
Oncology. 1993 Apr;50 Suppl 1:63-9. doi: 10.1159/000227248.
One hundred and ten patients with primary epidermoid cancers of the anal canal were treated in a series of prospectively designed, nonrandomized protocols of split-course radiation therapy with concurrent administration of 5-fluorouracil (5-FU) with or without mitomycin. The addition of mitomycin was associated with improved primary tumor control rates (87 vs. 58% at 4 years, p = 0.005) and improved 4-year actuarial cause-specific survival (80 vs. 64%, p = 0.02). Hematologic toxicity was the most frequent acute side effect of mitomycin use. No long-term toxicity was attributed to mitomycin only. Mitomycin appeared to benefit patients principally through improved control of cancer in the irradiated volume; there was no evidence of reduced risk of extrapelvic metastases. Several investigators have reported high rates of control of epidermoid anal cancers with preservation of anorectal function following concurrent treatment with mitomycin, 5-FU, and radiation. Mitomycin's role in anal cancer is being evaluated in a randomized clinical trial by the Radiation Therapy Oncology Group. The mechanisms of any interactions between mitomycin and radiation or other cytotoxic drugs in clinical practice remain to be determined.
110例肛管原发性表皮样癌患者接受了一系列前瞻性设计的非随机分割疗程放射治疗方案，同时给予5-氟尿嘧啶（5-FU），部分患者加用丝裂霉素。加用丝裂霉素与原发性肿瘤控制率提高相关（4年时分别为87%和58%，p = 0.005），4年精算特定病因生存率也有所提高（分别为80%和64%，p = 0.02）。血液学毒性是使用丝裂霉素最常见的急性副作用。未发现仅由丝裂霉素导致的长期毒性。丝裂霉素似乎主要通过改善照射野内癌症的控制而使患者获益；没有证据表明盆腔外转移风险降低。几位研究者报告，在丝裂霉素、5-FU和放疗联合治疗后，表皮样肛管癌的控制率较高，且保留了肛门直肠功能。放射治疗肿瘤学组正在通过一项随机临床试验评估丝裂霉素在肛管癌中的作用。在临床实践中，丝裂霉素与放疗或其他细胞毒性药物之间任何相互作用的机制仍有待确定。
