Peiffert D, Bey P, Pernot M, Guillemin F, Luporsi E, Hoffstetter S, Aletti P, Boissel P, Bigard M A, Dartois D, Baylac F
Radiotherapy Department, Centre Alexis Vautrin, Nancy, France.
Int J Radiat Oncol Biol Phys. 1997 Jan 15;37(2):313-24. doi: 10.1016/s0360-3016(96)00493-2.
We analyzed in a retrospective series of patients treated by conservative irradiation for an epidermoid cancer of the anal canal (ECAC) the prognostic factors of locoregional control (LRC), survival, late severe complications (LSC), and sphincter conservation (SC).
From 1976 until 1994, 118 patients presenting with an ECAC were conservatively treated (mean age, 65 years). According to the 1987 International Union Against Cancer (TNM) classification, they were: 19 T1, 70 T2, 22 T3, 7 T4, 94 N0, and 24 N1-3. The treatment started with external beam irradiation (EBI) (36 Gy in 3 weeks or 45 Gy in 5 weeks). Concomitant chemotherapy (5-fluorouracil and mitomycin C) was delivered to 31 patients. Two months later, a boost of 20 Gy was delivered by interstitial 192Ir brachytherapy to 101 patients and EBI in 5. Twelve other patients had an abdominoperineal resection (APR). The mean follow-up was 6 years.
At 5 years the overall survival was 60%, and specific survival (SS) was 75%; it was 94% for T1, 79% for T2, 53% for T3, and 19% for T4. In multivariate analysis, tumor size (> or = 4 cm), node involvement, and no response to the EBI were factors of poor prognosis for SS. Thirty-two locoregional recurrences occurred of which 21 were local recurrences in the 106 patients treated by a conservative schedule. Only tumor size and response to the EBI were prognostic factors on multivariate analysis for local and LRC. A total of 17 patients presented with LSC (Grade 3, 16 patients; and Grade 4, 1 patient), which was treated by APR in 4 patients and colostomy in 11 (of which 7 were definitive). The only significant prognostic factor for LSC in the multivariate analysis was the total extrapolated response dose of irradiation. The definitive rate of SC after conservative treatment in cured patients was 100% for T1, 82% for T2, 58% for T3, and 100% for T4. Since 1989, improvements of the technique have allowed reduction of the LSC in maintaining the same local control.
The results of this series are similar to those of the literature. The confirmation of pretherapeutic prognostic factors related to response to the treatment should allow us to adapt the therapeutic intensity for each case to obtain better tumor control, with as few sequelae as possible, to yield a better rate of SC.
我们对一组接受保守放疗的肛管表皮样癌（ECAC）患者进行了回顾性分析，以研究局部区域控制（LRC）、生存率、晚期严重并发症（LSC）和括约肌保留（SC）的预后因素。
1976年至1994年，118例ECAC患者接受了保守治疗（平均年龄65岁）。根据1987年国际抗癌联盟（TNM）分类，患者情况如下：19例T1期，70例T2期，22例T3期，7例T4期，94例N0期，24例N1 - 3期。治疗始于外照射（EBI）（3周内36 Gy或5周内45 Gy）。31例患者接受了同步化疗（5 - 氟尿嘧啶和丝裂霉素C）。两个月后，101例患者接受了192Ir组织间近距离放疗剂量为20 Gy的推量照射，5例接受EBI推量。另外12例患者接受了腹会阴联合切除术（APR）。平均随访时间为6年。
5年时总生存率为60%，特异性生存率（SS）为75%；T1期为94%，T2期为79%，T3期为53%，T4期为19%。多因素分析显示，肿瘤大小（≥4 cm）、淋巴结受累及对EBI无反应是SS预后不良的因素。106例接受保守治疗方案的患者中发生了32例局部区域复发，其中21例为局部复发。多因素分析显示，仅肿瘤大小和对EBI的反应是局部和LRC的预后因素。共有17例患者出现LSC（3级16例；4级1例），4例患者接受了APR治疗，11例接受了结肠造口术（其中7例为永久性）。多因素分析中LSC的唯一显著预后因素是外推总照射剂量。治愈患者保守治疗后SC的确定率T1期为100%，T2期为82%，T3期为58%，T4期为100%。自1989年以来，技术改进使得在维持相同局部控制的情况下LSC有所减少。
本系列结果与文献报道相似。对与治疗反应相关的治疗前预后因素的确认应使我们能够针对每个病例调整治疗强度，以获得更好的肿瘤控制，同时尽可能减少后遗症，提高SC率。
