High risk of colostomy with primary radiotherapy for anal cancer
High risk of colostomy with primary radiotherapy for anal cancer
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DOI：
10.1245/s10434-006-9118-5
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发表时间：
2007-01-01
影响因子：
3.7
通讯作者：
Zoetmulder, Frans A. N.
中科院分区：
文献类型：
--
作者：
de Bree, Eelco;van Ruth, Serge;Zoetmulder, Frans A. N.
背景：放射治疗（RT）已成为肛门癌的主要治疗选择，以避免结肠造口术。目前的作用，手术似乎普遍被低估，因为转向结肠造口术或腹会阴切除术似乎仍然经常是必要的并发症和局部治疗失败后RT。方法：83例患者的数据主要是由RT治疗的治愈意图在整个20年期间在我们的研究所进行了分析，关于结肠造口术的需要。结果：在平均39个月的随访期内，共有28名患者（34%）在初次RT后因局部失败或治疗相关并发症需要建立结肠造口术。3年精算无结肠造口率为59%（平均85 +/- 9个月）。在单因素分析中，早期疾病、低T评分和邻近器官无浸润与结肠造口术需求减少相关。在多变量分析中，只有T评分是预测无结肠造口间隔时间延长的独立变量。在这项研究中，没有统计学上的显着差异，注意到性别，年龄，淋巴结的状态，总辐射剂量，辐射增强和并发chemotherapy.Conclusions：在大约三分之一的患者治疗肛门括约肌保存管理与治愈的目标主要RT，结肠造口术的创建似乎是必要的RT并发症和局部治疗失败。因此，患者应充分了解直肠癌RT后需要结肠造口术的相当大的风险。
Background: Radiotherapy (RT) has become the primary treatment of choice for anal cancer in an effort to avoid colostomy. The current role of surgery appears generally to be underestimated, since diverting colostomy or abdominoperineal resection still often seems to be necessary for complications and local treatment failure after RT.Methods: The data of 83 patients primarily treated by RT with curative intent throughout a 20-year period in our institute were analyzed regarding the need for colostomy.Results: Totally, 28 patients (34%) required creation of a colostomy after primary RT for local failure or treatment-related complications during a mean follow-up period of 39 months. The 3-year actuarial colostomy-free rate was 59% (mean 85 +/- 9 months). Early stage disease, low T-score and absence of infiltration in adjacent organs were associated with a reduced need for colostomy in univariate analysis. In multivariate analysis only T-score was an independent variable in predicting prolonged colostomy-free interval. In this study, no statistically significant differences were noted for gender, age, nodal status, total radiation dose, radiation boost and concurrent chemotherapy.Conclusions: In approximately one-third of the patients treated by anal sphincter saving management with curative aimed primary RT, the creation of a colostomy appeared to be necessary for RT complications and local treatment failure. Therefore, patients should be well informed regarding the considerable risk of need for colostomy after RT for anal cancer.