Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press5910.17650/2220-3478-2012-0-4-9-14IN FOCUSВ ЦЕНТРЕ ВНИМАНИЯСombined treatment of squamous-cell anal cancerКомплексное лечение больных плоскоклеточным раком анального каналаKimD. F.КимД. Ф.
Russian Federation
kdf1976@rambler.ruNikolayevA. V.НиколаевА. В.
Russian Federation
BarsukovYu. A.БарсуковЮ. А.
Russian Federation
TkachevS. I.ТкачевС. И.
Russian Federation
GordeyevS. S.ГордеевС. С.
Russian Federation

Department of Oncology, Faculty of Therapeutics

Кафедра онкологии лечебного факультета

N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, MoscowФГБУ «РОНЦ им. Н.Н. Блохина» РАМН, МоскваI.M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaГБОУ ВПО «Первый МГМУ им. И.М. Сеченова» Минздрава России01032012149142802201528022015Copyright ©; 2012, ABV-pressCopyright ©; 2012, АБВ-пресс2012ABV-pressАБВ-прессhttps://onco-surgery.info/jour/about/editorialPolicieshttps://onco-surgery.info/jour/article/view/59

Since 1974 chemoradiation scheme proposed by Nigro remains the standard of care for squamous-cell anal cancer in most countries. Improvement of treatment results can be achieved by developing new treatment schemes including different radio- and chemosensitizers.

Methods. Results of treatment of 157 T1–4N0–2M0 squamous-cell anal cancer patients, which underwent treatment during 1990–2012 were analyzed. Patients were divided into 3 groups: group A received hyperfractionated radiotherapy (RT) single dose 1.2 Gy bid, total dose 40–44 Gy with 3–5 sessions of local hyperthermia (HT) during treatment; group B had similar RT + HT scheme with addition of chemotherapy (CT) with cisplatin 20 mg/m2 in days 1, 3 weeks 1–4 and bleomycin 15 mg in days 2, 4 weeks 1–4; group C had RT with single dose 2 Gy, same total dose, HT and CT as in group B and additionally received metronidazole 10 g/m2 per rectum in a polymeric composition. Two weeks after 1st treatment stage a second course of RT was carried out 20–24 Gy in 2 Gy fractions in all patient groups.

Results. Sphincter-sparing treatment was carried out in 11 (50 %), 71 (80.68 %) and 44 (93.62 %) in groups A, B and C accordingly. Three year overall survival (OS) was 60.0; 82.4; 96.4 %; 3-year disease-free survival (DFS) 36.6; 69.8 and 76.3 % accordingly.

Conclusions. In our study combined treatment using radiosensitization allow to improve sphincter preservation rate to 93 %, improve OS and DFS for squamous-cell anal cancer patients.

squamous-cell anal cancercombined treatmentchemoradiotherapymetronidazolelocal hyperthermiaradiosensitizerплоскоклеточный рак анального каналакомбинированная химиолучевая терапияметронидазоллокальная гипертермиярадиомодификатор1. Кныш В.И., Тимофеев Ю.М. Злокачественные опухоли анального канала. М., 1997.Кныш В.И., Тимофеев Ю.М. Злокачественные опухоли анального канала. М., 1997.2. Ryan D.P., Compton C.C., Mayer R.J. Carcinoma of the anal canal. N Engl J Med 2000;342:792–800.Ryan D.P., Compton C.C., Mayer R.J. Carcinoma of the anal canal. N Engl J Med 2000;342:792–800.3. Ramamoorthy S., Luo L., Luo E., Carethers J.M. Tobacco smoking and risk of recurrence for squamous cell cancer of the anus. Cancer Detect Prev 2008;32(2):116–20.Ramamoorthy S., Luo L., Luo E., Carethers J.M. Tobacco smoking and risk of recurrence for squamous cell cancer of the anus. Cancer Detect Prev 2008;32(2):116–20.4. Scholefield J.H., Nugent K.P. Anal Cancer. Position Statement of the Association of Coloproctology of Great Britain and Ireland Introduction, Colorectal Disease 2011 The Association of Coloproctology of Great Britain and Ireland. 13 (suppl 1):1–2.Scholefield J.H., Nugent K.P. Anal Cancer. Position Statement of the Association of Coloproctology of Great Britain and Ireland Introduction, Colorectal Disease 2011 The Association of Coloproctology of Great Britain and Ireland. 13 (suppl 1):1–2.5. Ajani J.A., Winter K.A., Gunderson L.L. et al. US intergroup anal carcinoma trial:Ajani J.A., Winter K.A., Gunderson L.L. et al. US intergroup anal carcinoma trial:tumor diameter predicts for colostomy. J Clin Oncol 2009;27(7):1116–21.6. Bartelink H., Roelofsen F., Eschwege F. et al. Concomitant radiotherapy andBartelink H., Roelofsen F., Eschwege F. et al. Concomitant radiotherapy andchemotherapy is superior to radiotherapy alone in the treatment of locally advancedanal 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 Oncol1997;15:2040–9.;15:2040–9.7. Flam M., John M., Pajak T.F. 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;14:2527–39.Flam M., John M., Pajak T.F. 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;14:2527–39.8. Ajani J.A., Winter K.A., Gunderson L.L. et al. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA 2008 Apr 23;299(16):1914–21.Ajani J.A., Winter K.A., Gunderson L.L. et al. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA 2008 Apr 23;299(16):1914–21.9. Epidermoid anal cancer: Results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 1996;348:1049–54.Epidermoid anal cancer: Results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet 1996;348:1049–54.10. James R., Meadows H.M. The second UK phase III anal cancer trial of chemoradiation and maintenance therapy (ACT II): Preliminary results on toxicity and outcome. Proc Am Soc Clin Oncol 2003;22:1151.James R., Meadows H.M. The second UK phase III anal cancer trial of chemoradiation and maintenance therapy (ACT II): Preliminary results on toxicity and outcome. Proc Am Soc Clin Oncol 2003;22:1151.11. Peiffert D., Gerard J.P., Ducreux M.et al. (2008) Induction chemotherapy (ict) and dose intensification of the radiation boost in locally advanced anal canal carcinoma (laacc): Definitive analysis of the Intergroup Accord 03 trial (Fйdйration Nationale des centres de lutte contre le cancer) Fondation Franзaise de Cancйrologie Digestive. Radiother Oncol 88(suppl 2):s20, abstr 65.Peiffert D., Gerard J.P., Ducreux M.et al. (2008) Induction chemotherapy (ict) and dose intensification of the radiation boost in locally advanced anal canal carcinoma (laacc): Definitive analysis of the Intergroup Accord 03 trial (Fйdйration Nationale des centres de lutte contre le cancer) Fondation Franзaise de Cancйrologie Digestive. Radiother Oncol 88(suppl 2):s20, abstr 65.12. Lim F., Glynne-Jones R., Chemotherapy/chemoradiation in anal cancer: a systematic review. Cancer Treat Rev 2011;37(7):520–32.Lim F., Glynne-Jones R., Chemotherapy/chemoradiation in anal cancer: a systematic review. Cancer Treat Rev 2011;37(7):520–32.13. Ries L.A.G., Harkins D., Krapcho M. et al. (eds). SEER Cancer Statistics Review, 1975–2003. Baltimore, MD: National Cancer Institute, 2005, p. 1–103.Ries L.A.G., Harkins D., Krapcho M. et al. (eds). SEER Cancer Statistics Review, 1975–2003. Baltimore, MD: National Cancer Institute, 2005, p. 1–103.14. Engstrom P.F., Arnoletti J.P., Benson A.B. III et al. NCCN clinical practice guidelinesEngstrom P.F., Arnoletti J.P., Benson A.B. III et al. NCCN clinical practice guidelinesin oncology. Anal carcinoma. J Natl Compr Canc Netw 2010;8(1):106–20.15. Marshall D.T., Thomas C.R. Jr. Carcinoma of the anal canal. Oncol Rev 2009;3:27–40.Marshall D.T., Thomas C.R. Jr. Carcinoma of the anal canal. Oncol Rev 2009;3:27–40.16. Nilsson P.J., Svensson C., Goldman S. Epidermoid anal cancer: a review of a population-based series of 308 consecutive patients treated according to prospective protocols. Int J Radiat Oncol Biol Phys 2005;61(1):92–102.Nilsson P.J., Svensson C., Goldman S. Epidermoid anal cancer: a review of a population-based series of 308 consecutive patients treated according to prospective protocols. Int J Radiat Oncol Biol Phys 2005;61(1):92–102.17. Малихов А.Г. Комбинированное и комплексное лечение больных плоскоклеточным раком прямой кишки. Дис. … канд. мед. наук. М., 2004.Малихов А.Г. Комбинированное и комплексное лечение больных плоскоклеточным раком прямой кишки. Дис. … канд. мед. наук. М., 2004.