EPIDERMOID ANAL CANCER - TREATMENT BY RADIATION ALONE OR BY RADIATION AND 5-FLUOROURACIL WITH AND WITHOUT MITOMYCIN-C
EPIDERMOID ANAL CANCER - TREATMENT BY RADIATION ALONE OR BY RADIATION AND 5-FLUOROURACIL WITH AND WITHOUT MITOMYCIN-C
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DOI：
10.1016/0360-3016(91)90265-6
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发表时间：
1991-10-01
影响因子：
7
通讯作者：
CATTON, CN
中科院分区：
文献类型：
--
作者：
CUMMINGS, BJ;KEANE, TJ;CATTON, CN
192例原发性肛管表皮样癌患者接受了一系列前瞻性设计的非随机序贯治疗方案，即单纯放疗(RT)、放疗联合5-氟尿嘧啶和丝裂霉素C(FUMIR)或单纯放疗联合5-氟尿嘧啶(FUR)。5年总生存率为69%，RT为68%，FUMIR为76%，为FUMIR%。放疗加或不加化疗总控制率为68%(130/191)，放疗为56%(32/57)，FUMIR为86%(59/69)，FUR为60%(39/65)。FUMIR的结果明显好于单纯RT或FUR，除2厘米大小的肿瘤外，这种优势在所有的T分期中都被发现。38例患者中，33例(87%)区域淋巴结转移得到控制。在任何治疗组中，临床上可检测到的区域淋巴转移的发现对存活率没有显著影响。在原发灶得到控制的患者中，88%的患者保留了肛门直肠功能，总体上，的患者保留了88%的肛门直肠功能。5FU和MMC同时给予不间断的根治性照射，50Gy20次/4周，产生严重的急性和晚期正常组织病变。分疗程治疗，并将每日分次剂量减少到2GY，减轻了正常组织损伤的严重程度。省略丝裂霉素C可降低急性血液学毒性，但与降低原发肿瘤控制率有关。根据存活率、原发肛门肿瘤控制率和保留肛门直肠功能的可能性来衡量，最有效的治疗方案包括在放射治疗的同时同时给予丝裂霉素C和5-氟尿嘧啶。
One hundred ninety-two patients with primary epidermoid cancer of the anal canal were treated by a series of prospectively designed, sequential non-randomized protocols of radiation alone (RT), radiation with concurrent 5-Fluorouracil and Mitomycin C (FUMIR), or radiation with concurrent 5-Fluorouracil only (FUR). The 5-year cause-specific survival rates were 69% overall, 68% RT, 76% FUMIR, 64% FUR. The primary tumor was controlled by radiation with or without chemotherapy in 68% (130/191) overall, 56% (32/57) by RT, 86% (59/69) by FUMIR, 60% (39/65) by FUR. The results with FUMIR were significantly better than with either RT alone or FUR, and except in tumors up to 2 cm in size, this superiority was found in all T stages. Regional lymph node metastases were controlled in 33 of 38 (87%) overall. The finding of clinically detectable regional lymph node metastases at presentation did not affect survival significantly in any treatment group. Anorectal function was preserved in 88% of the patients in whom the primary tumor was controlled, and in 64% overall. The delivery of 5FU and MMC concurrently with uninterrupted radical irradiation, 50 Gy in 20 fractions in 4 weeks, produced severe acute and late normal tissue morbidity. Split course treatment, and reduction of the daily fractional dose to 2 Gy, diminished the severity of normal tissue damage. Omission of Mitomycin C reduced acute hematological toxicity, but was associated with a decreased primary tumor control rate. The most effective treatment protocols as measured by survival rates, primary anal tumor control rates, and the likelihood of conservation of anorectal function included the administration of both Mitomycin C and 5-Fluorouracil concurrently with radiation therapy.