Concurrent chemotherapy and intensity-modulated radiation therapy for anal canal cancer patients: A multicenter experience
Concurrent chemotherapy and intensity-modulated radiation therapy for anal canal cancer patients: A multicenter experience
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DOI：
10.1200/jco.2007.12.0170
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发表时间：
2007-10-10
影响因子：
45.3
通讯作者：
Chmura, Steven J.
中科院分区：
文献类型：
--
作者：
Salama, Joseph K.;Mell, Loren K.;Chmura, Steven J.
目的报告一个多中心的经验，同时化疗和调强放射治疗（IMRT）治疗肛管癌患者。患者和方法从2000年10月至2006年6月，53例患者接受同步化疗和调强放射治疗的肛门鳞状细胞癌在三个三级保健学术医疗中心。62%为T-2，67%为N 0; 8名患者为HIV阳性。48例患者接受氟尿嘧啶（FU）/丝裂霉素，1例接受FU/顺铂，4例仅接受FU。所有患者均接受了基于计算机断层扫描的治疗计划，骨盆区和腹股沟淋巴结接受的中位剂量为45戈伊。原发部位和受累淋巴结的中位剂量为51.5戈伊。根据不良事件通用术语标准3.0版对所有急性毒性进行评分。所有晚期毒性反应采用放射治疗肿瘤组criterions.Results评分，中位随访时间为14.5个月（范围5.2 ~ 102.8个月）。急性3 +级毒性包括15.1%的GI和37.7%的皮肤毒性;所有急性4级毒性均为血液学毒性;分别有30.2%和34.0%的患者发生急性4级白细胞减少和中性粒细胞减少。41.5%的患者发生治疗中断，中位持续时间为4天。49名患者（92.5%）完全缓解，1名患者部分缓解，3名患者病情稳定。所有HIV阳性患者均获得完全缓解。18个月的结肠造口生存率，总生存率，从局部失败，从远端失败的自由度分别为83.7%，93.4%，83.9%，和92.9%.Conclusion初步结果表明，同步化疗和调强放射治疗肛管癌是有效的，耐受性良好的历史标准相比。
Purpose To report a multicenter experience treating anal canal cancer patients with concurrent chemotherapy and intensity-modulated radiation therapy (IMRT).Patients and Methods From October 2000 to June 2006, 53 patients were treated with concurrent chemotherapy and IMRT for anal squamous cell carcinoma at three tertiary-care academic medical centers. Sixty-two percent were T-2, and 67% were N0; eight patients were HIV positive. Forty-eight patients received fluorouracil (FU)/mitomycin, one received FU/cisplatin, and four received FU alone. All patients underwent computed tomography-based treatment planning with pelvic regions and inguinal nodes receiving a median of 45 Gy. Primary sites and involved nodes were boosted to a median dose of 51.5 Gy. All acute toxicity was scored according to the Common Terminology Criteria for Adverse Events, version 3.0. All late toxicity was scored using Radiation Therapy Oncology Group criteria.Results Median follow-up was 14.5 months (range, 5.2 to 102.8 months). Acute grade 3 + toxicity included 15.1% GI and 37.7% dermatologic toxicity; all acute grade 4 toxicities were hematologic; and acute grade 4 leukopenia and neutropenia occurred in 30.2% and 34.0% of patients, respectively. Treatment breaks occurred in 41.5% of patients, lasting a median of 4 days. Forty-nine patients (92.5%) had a complete response, one patient had a partial response, and three had stable disease. All HIV-positive patients achieved a complete response. Eighteen-month colostomy-free survival, overall survival, freedom from local failure, and freedom from distant failure were 83.7%, 93.4%, 83.9%, and 92.9%, respectively.Conclusion Preliminary outcomes suggest that concurrent chemotherapy and IMRT for anal canal cancers is effective and tolerated favorably compared with historical standards.