Background and Aim

This study aimed to determine treatment outcomes and factors affecting prognosis in patients diagnosed with anal canal cancer who received radical radiotherapy (RT) or radiotherapy combined with chemotherapy (CT-RT) in radiation oncology centers in Turkey and compare the results with literature.

Material and Method

The study included 193 patients with anal canal cancer reported between 1995 and 2019, of which 162 had complete data. The study was conducted in 11 radiation oncology centers, and a joint database was shared among them. Patients received radiotherapy doses of 45 Gy to 60 Gy. Data analysis was done using SPSS for Windows version 20.

Results

Median follow-up was 48.51 months (2-214). All patients received radiotherapy, and 140 (86.4%) received concurrent chemotherapy. Radiotherapy doses of 50.4 Gy to 60 Gy were administered to 74 patients (45.7%) using 2-dimensional-3-dimensional (2D-3D) conformal therapy and 70 patients (43.2%) using intensity modulated radiotherapy technique (IMRT). Acute phase hematologic toxicity was observed in 62 patients (38.3%), and nonhematologic toxicity in 123 patients (75.9%). The 5-year overall survival (OS) rate was 75.1% and disease-specific survival (DSS) rate was 76.4%. OS without colostomy was achieved in 79,8 % at 5 years, and complete response in 112 patients (69.1%). OS rate was significantly higher in 142 patients with positive response (P < .000) and 112 with complete response (P < .000). Anemia (P < .002), local progression, and systemic progression (P < .000) resulted in lower OS (P < .002). In univariate analysis, factors affecting OS rate were: gender, age, stage, lymph node status, T stage, RT treatment duration, and treatment planning with PET fusion, which were found to be statistically significant. Completing radiotherapy in less than 45 days, concurrent chemotherapy, and continued administration of mitomycin and 5 FU as chemotherapy had a significant positive effect on overall survival. OS rate was higher in patients receiving RT dose of 58 Gy or less and undergoing IMRT planning in radiotherapy. IMRT was associated with lower acute and late side effects.

Conclusion

Radiochemotherapy is the primary treatment for anal canal cancer and advanced radiotherapy techniques may increase survival by reducing side effects and improving treatment continuation. Higher treatment doses require further investigation. The efficacy of treatment can be improved by including patients treated with modern radiotherapy techniques in multicenter prospective studies using new and more effective chemotherapy and immunotherapy agents.

中文翻译：

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重新审视肛管癌的根治性放疗-放化疗结果：（TROD 胃肠组研究 02-005）

背景和目标

本研究旨在确定在土耳其放射肿瘤中心接受根治性放疗（RT）或放疗联合化疗（CT-RT）的肛管癌患者的治疗结果和影响预后的因素，并将结果与​​文献进行比较。

材料与方法

该研究纳入了1995年至2019年间报告的193例肛管癌患者，其中162例有完整数据。该研究在 11 个放射肿瘤中心进行，并共享一个联合数据库。患者接受45 Gy至60 Gy的放射治疗剂量。使用 SPSS for Windows 版本 20 进行数据分析。

结果

中位随访时间为 48.51 个月 (2-214)。所有患者均接受放疗，140 例（86.4%）接受同步化疗。使用2维-3维(2D-3D)适形治疗的74名患者(45.7%)和使用调强放射治疗技术(IMRT)的70名患者(43.2%)接受了50.4 Gy至60 Gy的放射治疗剂量。62 名患者（38.3%）观察到急性期血液学毒性，123 名患者（75.9%）观察到非血液学毒性。5年总生存率（OS）为75.1%，疾病特异性生存率（DSS）为76.4%。5 年时，无需结肠造口术的 OS 达到 79.8%，112 名患者 (69.1%) 获得完全缓解。142 名阳性缓解 ( P < .000) 患者和 112 名完全缓解 ( P < .000) 患者的OS 率显着较高。贫血 ( P < .002)、局部进展和全身进展 ( P < .000) 导致 OS 降低 ( P < .002)。单因素分析显示，影响OS率的因素有：性别、年龄、分期、淋巴结状态、T分期、RT治疗持续时间、PET融合治疗计划，这些因素具有统计学意义。45天内完成放疗、同步化疗、持续给予丝裂霉素和5FU化疗对总生存期有显着的积极影响。接受 58 Gy 或以下放疗剂量并在放疗中接受 IMRT 计划的患者 OS 率较高。IMRT 与较低的急性和晚期副作用相关。

结论

放化疗是肛管癌的主要治疗方法，先进的放疗技术可以通过减少副作用和改善治疗持续性来提高生存率。更高的治疗剂量需要进一步研究。通过将接受现代放射治疗技术治疗的患者纳入使用新的、更有效的化疗和免疫治疗药物的多中心前瞻性研究，可以提高治疗效果。