Treatment Outcomes for Epidermoid Carcinoma of the Anal Canal in a Single Institution

“肛門類上皮癌”於單一醫療院所之治療成果

陳彥超(Yen-Chao Chen) ； 曾雁明(Nagn-Ming Tsang) ； 張富迪(Fu-Ti Chang) ； 洪志宏(Ji-Hong Hong)

《放射治療與腫瘤學》 12卷1期 (2005/03) Pp. 17-25

https://doi.org/10.6316/TRO/200512(1)17

摘要

目的：回溯性分析本院對『肛門類上皮癌』之治療成果。
材料與方法：從1989年11月至2002年3月，共有33經病理切片證實且新診斷之肛門類上皮癌病人，於本院接受以治癒為目的的放射線治療。其中第一、第二期的病人佔73%，而第三第四期的病人則佔27%。放射線的中位數劑量為54格雷(10-66.6 Gy)。其中有30位病人同時接受2個療程含5-fluorouracil的化學治療（1000mg/(平方公尺)/一天，連續滴注於第1-4天，第29-32天），併給予mitomyci-C（10-15 mg於第一天）亦或cisplatin（75mg/(平方公尺)，3小時滴注，於第1天和第29天）。所有病人於治療開始時皆無安排計畫性治療中斷或休息。
結果：追蹤時間之中位數為3年（0.1-14.1年）。於此33位病人中，有82%完成原先計畫給予的放射線劑量，但有48%的病人因嚴重會陰部或肛門周圍的皮膚反應需中斷治療達1星期以上。3年的實際『局部控制率』，『局部區域控制率』和『無須永久性人工肛門率』為71%，66%，79%；而3年（5年）之『無病存活率』，『疾病專一性存活率』和『總體存活率』則分別為41%(41%)，77%(72%)，66%(53%)。
結論：雖本院之『肛門類上皮癌』治療成果分析其各項觀察參數略遜於新近國外之文獻報告，但仍在可接受之範圍內；且可歸因於較少的總病人數，和包含較多身體狀況差或未完成治療的病人。以同步放療及化療可以保留肛門並控制腫瘤，但皮膚毒性是造成治療中斷的主要併發症。未來冀以新式之順形放射治療技術以減少毒性和不必要的治療中斷並改進成果。

關鍵字

肛門癌 ； 治療 ； 放射治療

並列摘要

Purpose: To retrospectively analyze treatment outcomes for epidermoid carcinoma of the anal canal in a single institution.
Materials and Methods: Between November 1989 and March 2002, thirty-three patients with biopsy-proven epidermoid carcinoma of the anal canal (Stage I-Ⅱ(73%), Ⅲ-Ⅳ(27%)) were treated by curative intent radiotherapy (RT). The median dose was 54 Gy (10-66.6 Gy). Two cycles of 5-fluorouracil-based chemotherapy (1000 mg/m^2/day, continuous infusion, days 1-4 and 29-32) either with mitomycin-C (10-15mg, bolus, day 1) or cisplatin (75mg/m^2, three hour infusion, day 1 and 29) were given concurrently to 30 patients. There were no scheduled breaks for any patients.
Results: The median follow-up time was three years (0.1-14.1 years). Of the 33 patients, 82% completed their planned RT doses, and 48% had a RT interruption of more than one week due to severe skin reactions. The median interval for RT was 8 weeks (1-14 weeks). The 3-year actuarial local control (LC), locoregional control (LRC) and permanent colostomy-free survival (CFS) were 71%, 66%, 79%, whereas the 3-year (estimated 5-year) disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS) were 41% (41%), 77% (72%), 66% (53%) respectively.
Conclusions: Outcomes at our institution with conventional anal cancer treatment were not outstanding, but were still comparable to other clinical trials. Organ preservation and durable local control can be obtained by concurrent chemoradiotherapy though significant skin toxicity is the major complication interrupting treatment. Innovative RT techniques and chemotherapy regimens certainly warrant further evaluation.

並列關鍵字

Anal cancer ； Treatment ； Radiotherapy