Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up
Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up
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DOI：
10.1016/j.radonc.2014.04.013
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发表时间：
2014-06-01
影响因子：
5.7
通讯作者：
Arnold, Dirk
中科院分区：
文献类型：
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作者：
Glynne-Jones, Robert;Nilsson, Per J.;Arnold, Dirk
肛门鳞状细胞癌(SCCA)是一种罕见的癌症，但其发病率在全球范围内呈上升趋势，尤其是在人类免疫缺陷病毒阳性(HIV+)人群中。多学科方法是强制性的(包括放射治疗师、内科肿瘤学家、外科医生、放射科医生和病理学家)。SCCA通常在肛管内外以区域性方式扩散。确诊时有30-40%的病例有淋巴结受累，而全身扩散不常见，首发时有5-8%的盆腔外远处转移，初次治疗后转移率在10%-20%之间。SCCA与人乳头瘤病毒(HPV，16-18型)感染密切相关。治疗的主要目标是通过局部区域控制和保留肛门功能来实现治愈，并尽可能地提高生活质量。治疗方法与低位直肠腺癌有很大不同。以5FU为基础的放化疗和其他细胞毒性药物(丝裂霉素C)的组合已被确立为治疗的标准，导致局部失败的患者中80%-90%的肿瘤完全消退在15%的范围内。外科抢救有一个公认的角色。在临床诊断时，应尽早在治疗大量患者的专科中心进行评估和治疗。到目前为止，仅有6个随机试验[1，2，3，4，5，6，7]的有限证据，癌症的罕见，以及取决于主要起源部位(肛缘、肛管或齿状线以上)的不同行为/自然病史，为任何一个肿瘤学家提供的指导都很有限。在这里，我们的目标是提供指南，可以帮助内科、放射和外科肿瘤学家对这种罕见的癌症进行实际处理。(C)2014年提交人。爱思唯尔爱尔兰有限公司出版。
Squamous cell carcinoma of the anus (SCCA) is a rare cancer but its incidence is increasing throughout the world, and is particularly high in the human immunodeficiency virus positive (HIV+) population. A multidisciplinary approach is mandatory (involving radiation therapists, medical oncologists, surgeons, radiologists and pathologists). SCCA usually spreads in a loco-regional manner within and outside the anal canal. Lymph node involvement at diagnosis is observed in 30-40% of cases while systemic spread is uncommon with distant extrapelvic metastases recorded in 5-8% at onset, and rates of metastatic progression after primary treatment between 10% and 20%. SCCA is strongly associated with human papilloma virus (HPV, types 16-18) infection. The primary aim of treatment is to achieve cure with loco-regional control and preservation of anal function, with the best possible quality of life. Treatment dramatically differs from adenocarcinomas of the lower rectum. Combinations of 5FU-based chemoradiation and other cytotoxic agents (mitomycin C) have been established as the standard of care, leading to complete tumour regression in 80-90% of patients with locoregional failures in the region of 15%. There is an accepted role for surgical salvage. Assessment and treatment should be carried out in specialised centres treating a high number of patients as early as possible in the clinical diagnosis. To date, the limited evidence from only 6 randomised trials [1,2,3,4,5,6,7], the rarity of the cancer, and the different behaviour/natural history depending on the predominant site of origin, (the anal margin, anal canal or above the dentate line) provide scanty direction for any individual oncologist. Here we aim to provide guidelines which can assist medical, radiation and surgical oncologists in the practical management of this unusual cancer. (C) 2014 The Authors. Published by Elsevier Ireland Ltd.