Valentini V, Mantello G, Leone M V, Luzi S, Turriziani A
Cattedra di Radioterapia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.
Rays. 1997 Jul-Sep;22(3):447-53.
Over a 9-year period, 52 patients with anal carcinoma were observed: there were 18 males and 34 females (ratio: 1:1.9); mean age was 62 years. In 37 patients (71%) the neoplasm origin was in the anal canal, in the margin in 14 (27%) and a coaclogenic form was located in the lower rectum in one. 39 patients (75%) showed an epidermoid carcinoma and 13 (25%) an adenocarcinoma. Treatment consisted in two cycles of 5FU (1000 mg/m2/24 h, day 1-4), mitomycin C (10 mg/m2 bolus, day 1) plus radiotherapy (23.4 Gy, split course with 4- week rest). At 6-8 weeks, brachytherapy was performed for epidermoid lesions of the anal canal and margin while adenocarcinomas were referred to surgery. Sphincter preservation at 5 years was 64%. In epidermoid carcinomas sphincter preservation was 69% vs 45% in adenocarcinomas (p = 0.17). In patients treated with a curative intent and presenting with epidermoid carcinoma of the anal canal, sphincter preservation was 77% vs no patient with adenocarcinoma of the anal canal. In 53% of patients with epidermoid carcinoma of the anal margin there was sphincter preservation. Overall 5-year survival was 62%, better for epidermoid carcinoma (69% vs 36%; p = 0.02) but similar as for the site (anal canal:62%; anal margin:60%).
在9年期间，观察了52例肛管癌患者：男性18例，女性34例（比例为1:1.9）；平均年龄62岁。37例患者（71%）肿瘤起源于肛管，14例（27%）起源于边缘，1例起源于下直肠的共生型。39例患者（75%）为表皮样癌，13例（25%）为腺癌。治疗包括两个周期的5-氟尿嘧啶（1000mg/m²/24小时，第1 - 4天）、丝裂霉素C（10mg/m²静脉推注，第1天）加放疗（23.4Gy，分程，休息4周）。在6 - 8周时，对肛管和边缘的表皮样病变进行近距离放疗，而腺癌则转诊手术。5年括约肌保留率为64%。在表皮样癌中，括约肌保留率为69%，腺癌为45%（p = 0.17）。在接受根治性治疗且患有肛管表皮样癌的患者中，括约肌保留率为77%，而肛管腺癌患者无保留。在53%的肛管边缘表皮样癌患者中有括约肌保留。总体5年生存率为62%，表皮样癌更好（69%对36%；p = 0.02），但按部位相似（肛管：62%；肛管边缘：60%）。
