肛管癌治疗进展

The progress in the treatment of anal canal cancer

肛管癌的发病在过去几十年明显升高,并且未来也将呈持续升高态势。随着对于肛管癌生物学行为的认识深入,治疗模式发生了根本性的改变。主要的治疗手段已经不再是有创的手术切除,放射治疗同步化疗不仅可以达到根治目的,而且避免了腹会阴联合切除术给患者带来人工肛门的困扰。同步放化疗作为一线治疗,其应用越来越广泛。5氟尿嘧啶+丝裂霉素在肛管癌的治疗中有明确的作用,可以提高完全缓解率、提高保肛率和无病生存率。当患者在同步放化疗结束后仍有肿瘤残存时,可以尝试挽救性同步放化疗或密切随诊,如果随诊肿瘤进展再行手术挽救。IMRT技术的应用,利于提高肛门区癌的剂量,同时保护小肠、膀胱、皮肤和股骨头等周围器官从而降低治疗副反应,减少治疗中断时间。靶向药物的应用给肛门癌的治疗带来了新的选择,但是有效性和安全性,需要更多研究数据支持。

The incidence of anal cancer has increased significantly in the past few decades, and itwill present a rising trend in the future. As for deeper understanding of the biological behavior of anal cancer,the treatment modality has changed. Primary treatment is no longer invasive surgical resection, concurrentchemo-radiotherapy could not only achieve the curative purpose, but also avoid the abdominal perineal resectionof patients with poor quality of life. Concurrent chemo-radiotherapy as first-line treatment of anal cancer,which has been proven by many studies, is applied more and more widely. 5-fluorouracil and mitomycin C asconcurrent chemotherapy regimen could improve the complete remission rate, sphincter preservation rate anddisease-free survival rate. Residual tumor after concurrent chemo-radiotherapy could be treated by salvagesurgery. The application of IMRT technology could improve the dosimetry of radiotherapy, while protecting the small intestine, bladder, skin and the femoral head to reduce the side effects of treatment, to minimize the interruption of treatment.Molecular targeted drugs added to the treatment of anal cancer has brought new options, but the effectiveness and safety of thecombination need more results from more prospective studies.