Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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The Results of Curative Concurrent Chemoradiotherapy for Anal Carcinoma

항문암 환자에서 근치적 목적의 동시 항암화학 방사선치료의 결과

  • Jeong, Jae-Uk (Department of Radiation Oncology, Chonnam National University Medical School) ;
  • Yoon, Mee-Sun (Department of Radiation Oncology, Chonnam National University Medical School) ;
  • Song, Ju-Young (Department of Radiation Oncology, Chonnam National University Medical School) ;
  • Ahn, Sung-Ja (Department of Radiation Oncology, Chonnam National University Medical School) ;
  • Chung, Woong-Ki (Department of Radiation Oncology, Chonnam National University Medical School) ;
  • Nah, Byung-Sik (Department of Radiation Oncology, Chonnam National University Medical School) ;
  • Nam, Taek-Keun (Department of Radiation Oncology, Chonnam National University Medical School)
  • 정재욱 (전남대학교 의과대학 방사선종양학교실) ;
  • 윤미선 (전남대학교 의과대학 방사선종양학교실) ;
  • 송주영 (전남대학교 의과대학 방사선종양학교실) ;
  • 안성자 (전남대학교 의과대학 방사선종양학교실) ;
  • 정웅기 (전남대학교 의과대학 방사선종양학교실) ;
  • 나병식 (전남대학교 의과대학 방사선종양학교실) ;
  • 남택근 (전남대학교 의과대학 방사선종양학교실)
  • Received : 2010.11.02
  • Accepted : 2010.12.06
  • Published : 2010.12.31
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Abstract

Purpose: To evaluate the predictive factors for treatment response and prognostic factors affecting survival outcomes after concurrent chemoradiotherapy (CCRT) for patients with anal squamous cell carcinoma. Materials and Methods: Medical records of forty two patients with histologically confirmed analsquamous cell carcinoma, who had complete CCRT between 1993 and 2008, were reviewed retrospectively. Median age was 61.5 years (39~89 years), and median radiotherapy (RT) dose was 50.4 Gy (30.0~64.0 Gy). A total of 36 patients had equal to or less than T2 stage (85.7%). Fourteen patients (33.3%) showed regional nodal metastasis, 36 patients (85.7%) were treated with 5-fluorouracil (5-FU) plus mitomycin, and the remaining patients were treated by 5-FU plus cisplatinum. Results: The median follow-up time was 62 months (2~202 months). The 5-year overall survival, loco regional relapse-free survival, disease-free survival, and colostomy-free survival rates were 86.0%, 71.7%, 71.7%, 78.2%, respectively. Regarding overall survival, the Eastern Cooperative Oncology Group (ECOG) performance status and complete response were found to be significant prognostic factors on univariate analysis. For multivariate analysis, only the ECOG performance status was significant. No significant factor was found for locoregional relapse-free survival or disease-free survival and similarly for treatment response, no significant factor was determined on logistic regression analysis. There were 7 patients who had local or regional recurrences and one patient with distant metastasis. The only evaluable toxicity in all patients was radiation dermatitis of perianal skin (grade 3), which developed in 4 patients (9.5%) and grade 2 in 22 patients (52.4%). Conclusion: This study revealed that patients with a performance score of ECOG 0-1 survived significantly longer than those with a poorer score. Finally, there was no significant predicting factors tested for treatment response.

목적: 항문암으로 근치적 목적의 동시 항암화학 방사선치료를 받은 환자들을 대상으로 치료반응의 예측인자, 생존율과 관련된 예후인자를 알아보고자 하였다. 대상 및 방법: 전남대학교병원에서 1993년부터 2008년까지 병리조직학적으로 항문의 편평상피세포암으로 진단받고 근치적 목적의 동시 항암화학 방사선치료를 받은 42명의 환자를 대상으로 후향적으로 분석하였다. 환자들 나이의 중앙값은 61.5세 (39~89에)였고 방사선량의 중앙값은 50.4 Gy (30.0~64.0 Gy)였다. T병기 상 2기 이하였던 환자는 총 36명 (85.7%)이었다. 영역림프절전이는 14명(33.3%)에서 있었다. 항암화학요법으로는 5-fluorouracil, mltomycin 병행요법으로 치료받은 환자가 36명 (85.7%)이었고 나머지는 5-fluorouracil, cisplatin 병행요법을 받았다. 결과: 전체 환자의 추적관찰기간의 중앙값은 62개월 (2~202개월)이었다. 5년 전체생존율, 국소영역제어율, 무병생존율, 무장루생존율은 각각 86.0%. 71.7%. 71.7%. 78.2%였다. 전체생존율과 관련된 인자로 단변량분석에서는 Eastem Cooperative Oncology Group (ECOG) 수행능력과 완전관해여부가 유의하였고 다변량분석에서는 ECOG 수행능력만이 유의하였다. 국소영역제어율, 무병생존율과 무장루생존률에 관련된 인자는 단변량이나 다변량분석 모두 유의한 인자는 없었다. 치료 후 완전관해 여부와 관련하여 유의하게 예측할 수 있는 인자는 없었다. 국소영역재발은 7명에서, 원격전이는 1명에서 발생하였다. 전체 환자에서 평가가 가능하였던 급성 부작용으로 3도의 피부염이 4명(9.5%), 2도는 22명(52.4%)에서 발생하였다. 결론: 본 연구에서 항문의 편평상피세포암에 대한 근치적 목적의 동시 항암화학 방사선치료로 양호한 생존율을 얻을 수 있었고, 특히 ECOG 수행능력이 1 이하인 환자의 생존율이 유의하게 높았다. 그러나 치료 후 종양반응을 예측할 수 있는 유의한 인자는 없었다.

Keywords

References

  1. Ministry of Health and Welfare, Korea Central Cancer Registry. 2007 Annual Report of the Korea Central Cancer Registry. Seoul; Ministry of Health and Welfare, 2009
  2. Nigro ND, Seydel HG, Considine B, Vaitkevicius VK, Leichman L, Kinzie JJ. Combined preoperative radiation and chemotherapy for squamous cell carcinoma of the anal canal. Cancer 1983;51:1826-1829 https://doi.org/10.1002/1097-0142(19830515)51:10<1826::AID-CNCR2820511012>3.0.CO;2-L
  3. Nigro ND, Vaitkevicius VK, Considine B Jr. Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum 1974;17:354-356 https://doi.org/10.1007/BF02586980
  4. Cummings BJ, Keane TJ, O'Sullivan B, Wong CS, Catton CN. Epidermoid anal cancer: treatment by radiation alone or by radiation and 5-fluorouracil with and without mitomycin C. Int J Radiat Oncol Biol Phys 1991;21:1115-1125 https://doi.org/10.1016/0360-3016(91)90265-6
  5. Goldman S, Glimelius B, Glas U, Lundell G, Pahlman L, Stahle E. Management of anal epidermoid carcinoma: an evaluation of treatment results in two population-based series. Int J Colorectal Dis 1989;4:234-243 https://doi.org/10.1007/BF01644988
  6. Myerson RJ, Karnell LH, Menck HR. The National Cancer Data Base report on carcinoma of the anus. Cancer 1997;80:805-815 https://doi.org/10.1002/(SICI)1097-0142(19970815)80:4<805::AID-CNCR20>3.0.CO;2-W
  7. Papillon J, Montbarbon JF. Epidermoid carcinoma of the anal canal. A series of 276 cases. Dis Colon Rectum 1987;30:324-333 https://doi.org/10.1007/BF02555448
  8. UKCCCR Anal Cancer Trial Working Party: UK Coordinating Committee on Cancer Research. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. Lancet 1996;348:1049-1054 https://doi.org/10.1016/S0140-6736(96)03409-5
  9. Bartelink H, Roelofsen F, Eschwege F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol 1997;15:2040-2049
  10. Boman BM, Moertel CG, O'Connell MJ, et al. Carcinoma of the anal canal. A clinical and pathologic study of 188 cases. Cancer 1984;54:114-125 https://doi.org/10.1002/1097-0142(19840701)54:1<114::AID-CNCR2820540124>3.0.CO;2-P
  11. Northover J, Glynne-Jones R, Sebag-Montefiore D, et al. Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I). Br J Cancer 2010;102:1123-1128 https://doi.org/10.1038/sj.bjc.6605605
  12. Flam M, John M, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy. and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 1996;14:2527-2539
  13. Thomas CR Jr, Stelzer KJ, Douglas JG, Koh WJ, Wood LV, Panicker R. Common emergencies in cancer medicine: infectious and treatment-related syndromes, Part II. J Natl Med Assoc 1994;86:839-852
  14. Ajani JA, Winter KA, Gunderson LL, et al. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA 2008;299:1914-1921 https://doi.org/10.1001/jama.299.16.1914
  15. Matzinger O, Roelofsen F, Mineur L, et al. Mltomycin C with continuous fluorouracil or with cisplatin in combination with radiotherapy for locally advanced anal cancer Organisation for Research and Treatment of Cancer phase II study 22011-40014). Eur J Cancer 2009:45:2782-2791 https://doi.org/10.1016/j.ejca.2009.06.020
  16. Lee DH, Kim I, Song HH, et al. Induction chemotherapy followed by radiotherapy in the treatment of anal cancer. Oncol Rep 2003;10:101-104
  17. Conroy T, Ducreux M, Lemanski C, et al. Treatment intensification by induction chemotherapy (lCT) and radiation dose escalation In locally advanced squamous cell anal canal carcinoma (LAAC): Definitive analysis of the intergroup ACCORD 03 trial. J Clin Oncol 2009:27(15S):4033
  18. Hughes LL, Rich TA, Delclos L, Ajani JA, Martin RG. Radiotherapy for anal cancer: experience from 1979-1987. Int J Radiat Oncol Biol Phys 1989;17:1153-1160 https://doi.org/10.1016/0360-3016(89)90520-8
  19. Deniaud-Alexandre E, Touboul E, Tiret E, et al. Results of definitive irradiation in a series of 305 epidermoid carcinomas of the anal canal. Int J Radiat Oncol Biol Phys 2003;56:1259-1273 https://doi.org/10.1016/S0360-3016(03)00417-6
  20. Schwarz JK, Siegel BA, Dehdashti F, Myerson RJ, Fleshman JW, Grigsby PW. Tumor response and survival predicted by post-therapy FDG-PET/CT in anal cancer. Int J Radiat Oncol Biol Phys 2008;71:180-186 https://doi.org/10.1016/j.ijrobp.2007.09.005
  21. Martenson JA, Lipsitz SR, Lefkopoulou M, et al. Results of combined modality therapy for patients with anal cancer (E7283). An Eastern Cooperative Oncology Group study. Cancer 1995;76:1731-1736 https://doi.org/10.1002/1097-0142(19951115)76:10<1731::AID-CNCR2820761009>3.0.CO;2-H
  22. Chie EK, Ha SW, Park JG, Bang YJ, Heo DS, Kim NK. Treatment results in anal cancer: non-operative treatment versus operative treatment. J Korean Soc Ther Radiol Oncol 2002;20:62-67
  23. Konski A, Garcia M Jr, John M, et al. Evaluation of planned treatment breaks during radiation therapy for anal cancer: update of RTOG 92-08. Int J Radiat Oncol Biol Phys 2008;72:114-118 https://doi.org/10.1016/j.ijrobp.2007.12.027
  24. Doci R, Zucali R, Bombelli L, Montalto F, Lamonica G. Combined chemoradiation therapy for anal cancer: a report of 56 cases. Ann Surg 1992;215:150-156 https://doi.org/10.1097/00000658-199202000-00010