同期加量调强放疗联合卡培他滨治疗肛管癌的疗效分析

Preliminary Results of Simultaneous Integrated Boost-Intensity Modulated Radiation Therapy with Concurrent Capecitabine Chemotherapy for Anal Cancer

目的：探讨肛管癌行同期加量调强放疗并同步卡培他滨化疗的可行性、安全性及近期疗效。方法：2009年9月—2014年2月收治的10例肛管癌患者均接受同期加量调强放疗：给予原发灶肉眼可及淋巴结1.8 Gy/次×32次,总剂量57.6 Gy;双侧髂血管及腹股沟淋巴引流区1.5 Gy/次×32次,总剂量48 Gy;并同步口服卡培他滨化疗,625 mg/m2,2次/d,5 d/周。2例患者由于治疗至5周时仍有肉眼残存病灶,继续加量（1.8 Gy×2次）至结束治疗。急性及晚期不良反应评价按照通用不良事件术语标准4.0版。结果：所有患者均顺利完成放化疗方案,皮肤3级不良反应发生率为50%（5/10）,无4级以上不良反应发生。中位随访20个月（6~60个月）,2年局控率、无结肠造瘘生存率、无远处转移生存率及总生存率为100%（10/10）、90%（9/10）、90%（9/10）和90%（9/10）。结论：肛管癌同期加量调强放疗并同步卡培他滨化疗是一个可接受的安全方案,其潜力尚需更多的样本量及长期的随访来评估。

Objective：To assess the feasibility,safety and short-term outcome of simultaneous integrated boost-intensity modulated radiation therapy（SIB-IMRT）with concurrent capecitabine chemotherpay for anal cancer.Methods：A total of 10 hospitalized patients with anal cancer during Sep.2009 and Feb.2014 were treated with SIB-IMRT.A total dosage of 57.6 Gy was given to the primary lesion and macroscopical lymph nodes in 32 fractions,with 1.8 Gy in each fraction.And a total dosage of 48 Gy was given to the bilateral iliac vessels and inguinal lymphatic drainage region in 32 fractions,with 1.5 Gy in each fraction.And capecitabine was concurrently administered at the oral dose of 625 mg/m2,twice daily,5 days per week.Two patients received a sequential radiation boost dose of 2×1.8 Gy due to macroscopic residual lesion at week5 of treatment.Acute and late adverse reaction was assessed according to the Common Terminology Criteria for Adverse Events version 4.0.Results：All patients completed radio-chemotherapy without any treatment break.The incidence rate of grade 3 skin adverse reaction was 50%（5/10）.No grade 4 adverse reaction was observed.Mean follow-up was 20 months（range 6-60 months）.The2-year-local control,colostomy-free survival,distant metastases-free survival and overall survival rates were 100%（10/10）,90%（9/10）,90%（9/10）,and 90%（9/10）,respectively.Conclusions：SIB-IMRT with concurrent capecitabine chemotherapy：an acceptable safe regimen,however,more samples and a longer follow-up are required to assess its potential superiority.