手术不再是肛管鳞癌的首选标准治疗模式:ESMO肛管癌临床实践指南解读

Surgery is no longer the standard upfront treatment for squamous carcinoma of anal canal——brief introduction of the 2014 ESMO guideline for anal cancer

2014年ESMO肛管鳞癌指南适用于肛管、肛门及肛周皮肤起源的鳞状细胞癌的临床诊疗。应该识别的高危因素包括是否经肛门性行为、HIV及HPV感染。肛管癌的分期标准依然是UICC/AJCC的TNM分期系统。局限性肛管癌的治疗目的是在获得良好的肿瘤局部控制基础上保全肛门功能。标准治疗是以5-FU为基础的同步放化疗(CRT)联合其他全身化疗药物,临床完全缓解率可达80%~90%,手术可作为多数I^III期肛管癌的挽救性治疗手段或早期肛周皮肤癌的主要治疗手段;转移性肛管癌的治疗主要是全身化疗,最常用的是顺铂联合5-FU的方案。可考虑联合局部放射治疗,以控制原发灶局部症状。

The 2014 ESMO guideline for anal cancer is used for diagnosis, treatment and follow-upof squamous cell carcinoma of the anus, including anatomically anal canal, anal margin and perianal skin.High risk includes anal intercourse, HIV infection and HPV infection. The current staging system for analcancer is still the UICC/AJCC TNM classification for malignant tumor. Treatment goal for localized analcancer is to achieve good control for primary lesion and preserve the function of anal sphincter. Standardprimary treatment for this setting is 5-fluorouracil (5-FU)-based concurrent chemoradiation (CRT), leadingto complete tumour regression in 80%~90% of patients. In this setting, surgery is used mainly as a salvage treatment, or the primary option for small lesion involving perianal skin. For metastatic disease, systemic chemotherapy with 5-FUand cisplatin-based regimen is the primary treatment.