调强放疗联合同步化疗治疗肛管鳞癌的远期疗效及预后

Long-term efficacy and prognosis of intensity-modulated chemoradiotherapy for patients with anal squamous cell carcinoma

目的分析肛管鳞癌调强放疗联合同步化疗的疗效并进行预后影响因素分析.方法回顾性分析2010年1月1日至2022年1月1日于中国医学科学院肿瘤医院行调强放疗联合同步化疗的肛管鳞癌患者的临床资料,并定期随访患者.主要观测指标为无瘤生存(DFS)、无局部区域复发生存(LRFFS)和总生存(OS),并记录不良反应情况.采用Kaplan-Meier法绘制生存曲线,用Cox回归模型分析生存的影响因素.结果共纳入65例患者,男性19例(29%),女性46例(71%).根据美国癌症联合委员会(AJCC)第7版分期,Ⅰ期、Ⅱ期、Ⅲa期、Ⅲb期分别有7例(11%)、28例(43%)、10例(15%)、20例(31%).同步放化疗前,2例(3%)患者接受了化疗,12例(18%)接受局部切除手术.原发灶的放疗中位剂量为54 Gy(范围为45~64 Gy),同步化疗的方案以卡培他滨联合丝裂霉素为主(34例,52%).同步放化疗期间放疗完成率为100%,化疗完成率为88%,5例(8%)患者出现治疗中断但足量完成治疗,8例(12%)患者化疗剂量降低.同步放化疗期间,15例(23%)患者发生3-4级白细胞减少,17例(26%)发生3-4级放射性皮炎,无治疗相关死亡.中位随访时间为50.4个月(范围为4.4~142.2个月),7例(11%)患者出现局部区域复发,3例(5%)出现远处转移.全组5年DFS率、LRFFS率和OS率分别为78.8%、86.5%和85.1%.Cox单因素分析提示T分期与DFS率显著相关(P=0.006),并与OS率有相关趋势(P=0.054).结论调强放疗联合同步化疗可有效治疗肛管鳞癌患者,急性不良反应基本可耐受.T分期是肛管鳞癌患者DFS率的影响因素.

Objective To analyze clinical efficacy of intensity-modulated chemoradiotherapy for patients with anal squamous cell carcinoma and identify prognostic factors.Methods Clinical data of patients with anal squamous cell carcinoma who received intensity-modulated chemoradiotherapy in the Cancer Hospital of Chinese Academy of Medical Sciences from January 1,2010 to January 1,2022 were retrospectively analyzed.Regular follow-up was carried out.The main indexes included disease-free survival(DFS),locoregional failure-free survival(LRFFS)and overall survival(OS),and adverse reactions were recorded.The survival curve was delineated by Kaplan-Meier method and the influencing factors of survival were analyzed by Cox regression models.Results A total of 65 patients were enrolled with 19(29%)males and 46(71%)females.According to the American Joint Committee on Cancer(AJCC)7th edition staging,there were 7(11%),28(43%),10(15%),and 20(31%)patients with stageⅠ,Ⅱ,Ⅲa,andⅢb,respectively.Before the chemoradiotherapy,2(3%)patients received chemotherapy and 12(18%)patients received local resection.The median dose of radiotherapy was 54 Gy(range:45-64 Gy)and the main concurrent chemotherapy regimen was capecitabine combined with cisplatin(n=34,52%).The completion rate of radiotherapy during concurrent chemoradiotherapy was 100%,and the chemotherapy completion rate was 88%.During the therapy,5 patients(8%)were interrupted but completed concurrent chemoradiotherapy in full dose,and 8 patients(12%)reduced the dose of concurrent chemotherapy due to the toxicities.During the chemoradiotherapy,15 cases(23%)experienced grade 3-4 leukopenia,and 17 cases(26%)experienced grade 3-4 radiation dermatitis.No treatment-related death occurred during the treatment.The median follow-up time was 50.4 months(range:4.4-142.2 months),local recurrence occurred in 7 cases(11%),distant metastasis occurred in 3 cases(5%),and the 5-year DFS,LRFFS and OS rates were 78.8%,86.5%and 85.1%,respectively.Cox univariate analysis indicated that T stage was significantly associated with DFS(P=0.006),and tended to be associated with OS(P=0.054).Conclusions Intensity-modulated radiotherapy combined with concurrent chemotherapy is an effective treatment for anal squamous cell carcinoma,with tolerable acute toxicities.T stage is an influencing factor of DFS in anal squamous cell carcinoma patients.