肛門部扁平上皮癌に対する化学放射線療法の治療成績
目的：肛門部扁平上皮癌（SCC）に対する化学放射線療法（CRT）の治療効果を検討した．対象と方法：CRTが施行された肛門部SCC 15例を対象とし，その治療成績を後方視的に検討した．結果：全例が放射線治療を完遂しえたが，Grade 3以上の副作用を3例に認め，6例は化学療法を減量投与した．局所の治療効果は全例がCRであったが，4例（26.7％）に再発を認めた．化学療法の非減量例の再発は1例（10％）で，T2以下の非減量例では再発を認めなかった．再発部位はいずれも局所であった．再発までの期間が1年以内であった3例はいずれも化学療法の減量例であった．予後は原癌死を3例，他病死を3例に認めたが，再発...
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| Published in | 日本大腸肛門病学会雑誌 Vol. 76; no. 1; pp. 1 - 7 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
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日本大腸肛門病学会
2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0047-1801 1882-9619 |
| DOI | 10.3862/jcoloproctology.76.1 |
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| Abstract | 目的：肛門部扁平上皮癌（SCC）に対する化学放射線療法（CRT）の治療効果を検討した．対象と方法：CRTが施行された肛門部SCC 15例を対象とし，その治療成績を後方視的に検討した．結果：全例が放射線治療を完遂しえたが，Grade 3以上の副作用を3例に認め，6例は化学療法を減量投与した．局所の治療効果は全例がCRであったが，4例（26.7％）に再発を認めた．化学療法の非減量例の再発は1例（10％）で，T2以下の非減量例では再発を認めなかった．再発部位はいずれも局所であった．再発までの期間が1年以内であった3例はいずれも化学療法の減量例であった．予後は原癌死を3例，他病死を3例に認めたが，再発手術後の1例を含む9例が無病生存中である．結語：肛門部SCCに対するCRTは安全に施行が可能で，根治が期待されるが，化学療法の減量例では早期の局所再発に配慮したフォローアップが必要と考えられた． |
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| AbstractList | 目的：肛門部扁平上皮癌（SCC）に対する化学放射線療法（CRT）の治療効果を検討した．対象と方法：CRTが施行された肛門部SCC 15例を対象とし，その治療成績を後方視的に検討した．結果：全例が放射線治療を完遂しえたが，Grade 3以上の副作用を3例に認め，6例は化学療法を減量投与した．局所の治療効果は全例がCRであったが，4例（26.7％）に再発を認めた．化学療法の非減量例の再発は1例（10％）で，T2以下の非減量例では再発を認めなかった．再発部位はいずれも局所であった．再発までの期間が1年以内であった3例はいずれも化学療法の減量例であった．予後は原癌死を3例，他病死を3例に認めたが，再発手術後の1例を含む9例が無病生存中である．結語：肛門部SCCに対するCRTは安全に施行が可能で，根治が期待されるが，化学療法の減量例では早期の局所再発に配慮したフォローアップが必要と考えられた． |
| Author | 須田, 康一 浅野, 之夫 升森, 宏次 荒川, 敏 佐藤, 美信 加藤, 宏之 堀口, 明彦 小出, 欣和 |
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| References | 4) 鮫島伸一, 澤田俊夫, 長廻 鉱:本邦における肛門扁平上皮癌, 痔瘻癌の現況, 第59回大腸癌研究会アンケート調査報告. 日本大腸肛門病会誌 58:415-421, 2005 7) 濱口哲弥:Lower G. 1. /Colon and Rectum Cancer 大腸癌 下部消化管腫瘍─希少領域の治療─ III. 肛門管扁平上皮癌. 癌と化療 45:1598-1601, 2018 10) Indinnimeo M, Reale MG, Cicchini C, et al: CEA, TPA, CA 19-9, SCC and CYFRA at diagnosis and in the follow-up of anal canal tumors. Int Surg 82:275-279, 1997 15) James R, Wan S, Glynne-Jones R, et al: A randomized trial of chemoradiation using mitomycin or cisplatin, with or without maintenance cisplatin/5FU in squamous cell carcinoma of the anus (ACT II). J Clin Oncol 27 (June 20 Suppl) :LBA4009, 2009 6) 大腸癌研究会編:大腸癌取扱い規約, 改訂第9版版. 金原出版, 東京, 2018 23) Schiller DE, Cummings BJ, Rai S, et al: Outcomes of salvage surgery for squamous cell carcinoma of the anal canal. Ann Surg Oncol 14:2780-2789, 2007 17) Glynne-Jones R, Meadows H, Wan S, et al: EXTRA-A multicenter phase II study of chemoradiation using a 5 days per week oral regimen of capecitabine and intravenous mitomycin C in ana cancer. Int J Radiat Oncol Biol Phys 72:119-126, 2008 3) National Comprehensive Cancer Network: Anal carcinoma. Version 1. 2022. https://www.nccn.org/professionals/physician_gls/pdf/anal.pdf. Accessed May 11, 2022. 14) 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 15:2040-2049, 1997 11) Takashima A, Shimada Y, Hamaguchi T, et al: A phase I/II trial of chemoradiotherapy concurrent with S-1 plus mitomycin C in patients with clinical stage II/III squamous cell carcinoma of anal canal (JCOGO903: SMA RT-AC). Jpn J Clin Oncol 41:713-717, 2011 21) McKibbin T, Frei CR, Greene RE, et al: Disparities in the use of chemotherapy and monoclonal antibody therapy for elderly advanced colorectal cancer patients in the community oncology setting. Oncologist 13:876-885, 2008 13) Gunderson LL, Winter KA, Ajani JA, et al: Long-term update of US GI Intergroup RTOG 98-11. A phase III trial for anal carcinoma: survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomicin, versus fluorouracil/cisplatin. J Clin Oncol 30:4344-4351, 2012 18) Meulendijks D, Dewit L, Tomasos NB, et al: Chemoradiotherapy with capecitabine for locally advanced anal carcinoma: an alternative treatment option. Br J Cancer 111:1726-1733, 2014 24) Wright JL, Patil SM, Temple LK, et al: Squamous cell carcinoma of the anal canal: patterns and predictors of failure and implications for intensity-modulated radiation treatment planning. Int J Radiat Oncol Biol Phys 78:1064-1072, 2010 19) Lefèvre JH, Corte H, Tiret E, et al: Abdominoperineal resection for squamous cell anal carcinoma: survival and risk factors for recurrence. Ann Surg Oncol 19:4186-4192, 2012 20) 日本腎臓学会, 日本癌治療学会, 日本臨床腫瘍学会ほか編:がん薬物療法時の腎機能診療ガイドライン2016. ライフサイエンス出版, 東京, 2016, p15-17 8) 松田圭二, 八木貴博, 塚本充雄ほか:肛門管悪性 腫瘍の臨床的特徴と治療方針. 胃と腸 51:295-308, 2016 16) Conroy T, Ducreux M, Lemanski C, et al: Treatment intensification by induction chemotherapy (ICT) and radiation dose escalation in locally advanced squamous cell anal carcinoma (LAAC) : Definitive analysis of the intergroup ACCORD 03 trial. J Clin Oncol 27 (Suppl 15s) :4033, 2009 9) Yamada K, Saiki Y, Komori K, et al: Characteristics of anal canal cancer in Japan. Cancer Med 11:2735-2743, 2022 2) Nigro ND, Vaitkeviius VK, Considine B Jr: Combined therapy for cancer of anal canal: A preliminary report. Dis Colon Rectum 17:354-356, 1974 5) Brierley JD, Gospodarowicz MK, Wittekind C (ed) : TNM Classification of Malignant Tumors, 8th ed. New York, Wiley-Liss, 2016, p77-79 22) Miller SH, Rudolph R: Healing in the irradiated wound. Clin Plast Surg 17:503-508, 1990 1) Sato H, Koh PK, Bartolo DCC: Management of anal canal cancer. Dis Colon Rectum 48:1301-1315, 2005 12) Takashima A, Shimada Y, Hamaguchi T, et al: Current therapeutic strategies for anal squamous cell carcinoma in Japan. Int J Clin Oncol 14:416-420, 2009 25) Allal AS, Laurencet FM, Reymond MA, et al: Effectiveness of surgical salvage therapy for patients with locally uncontrolled anal carcinoma after sphincter-conserving treatment. Cancer 86:405-409, 1999 |
| References_xml | – reference: 1) Sato H, Koh PK, Bartolo DCC: Management of anal canal cancer. Dis Colon Rectum 48:1301-1315, 2005 – reference: 19) Lefèvre JH, Corte H, Tiret E, et al: Abdominoperineal resection for squamous cell anal carcinoma: survival and risk factors for recurrence. Ann Surg Oncol 19:4186-4192, 2012 – reference: 7) 濱口哲弥:Lower G. 1. /Colon and Rectum Cancer 大腸癌 下部消化管腫瘍─希少領域の治療─ III. 肛門管扁平上皮癌. 癌と化療 45:1598-1601, 2018 – reference: 10) Indinnimeo M, Reale MG, Cicchini C, et al: CEA, TPA, CA 19-9, SCC and CYFRA at diagnosis and in the follow-up of anal canal tumors. Int Surg 82:275-279, 1997 – reference: 14) 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 15:2040-2049, 1997 – reference: 12) Takashima A, Shimada Y, Hamaguchi T, et al: Current therapeutic strategies for anal squamous cell carcinoma in Japan. Int J Clin Oncol 14:416-420, 2009 – reference: 5) Brierley JD, Gospodarowicz MK, Wittekind C (ed) : TNM Classification of Malignant Tumors, 8th ed. New York, Wiley-Liss, 2016, p77-79 – reference: 15) James R, Wan S, Glynne-Jones R, et al: A randomized trial of chemoradiation using mitomycin or cisplatin, with or without maintenance cisplatin/5FU in squamous cell carcinoma of the anus (ACT II). J Clin Oncol 27 (June 20 Suppl) :LBA4009, 2009 – reference: 18) Meulendijks D, Dewit L, Tomasos NB, et al: Chemoradiotherapy with capecitabine for locally advanced anal carcinoma: an alternative treatment option. Br J Cancer 111:1726-1733, 2014 – reference: 23) Schiller DE, Cummings BJ, Rai S, et al: Outcomes of salvage surgery for squamous cell carcinoma of the anal canal. Ann Surg Oncol 14:2780-2789, 2007 – reference: 2) Nigro ND, Vaitkeviius VK, Considine B Jr: Combined therapy for cancer of anal canal: A preliminary report. Dis Colon Rectum 17:354-356, 1974 – reference: 16) Conroy T, Ducreux M, Lemanski C, et al: Treatment intensification by induction chemotherapy (ICT) and radiation dose escalation in locally advanced squamous cell anal carcinoma (LAAC) : Definitive analysis of the intergroup ACCORD 03 trial. J Clin Oncol 27 (Suppl 15s) :4033, 2009 – reference: 11) Takashima A, Shimada Y, Hamaguchi T, et al: A phase I/II trial of chemoradiotherapy concurrent with S-1 plus mitomycin C in patients with clinical stage II/III squamous cell carcinoma of anal canal (JCOGO903: SMA RT-AC). Jpn J Clin Oncol 41:713-717, 2011 – reference: 21) McKibbin T, Frei CR, Greene RE, et al: Disparities in the use of chemotherapy and monoclonal antibody therapy for elderly advanced colorectal cancer patients in the community oncology setting. Oncologist 13:876-885, 2008 – reference: 22) Miller SH, Rudolph R: Healing in the irradiated wound. Clin Plast Surg 17:503-508, 1990 – reference: 9) Yamada K, Saiki Y, Komori K, et al: Characteristics of anal canal cancer in Japan. Cancer Med 11:2735-2743, 2022 – reference: 24) Wright JL, Patil SM, Temple LK, et al: Squamous cell carcinoma of the anal canal: patterns and predictors of failure and implications for intensity-modulated radiation treatment planning. Int J Radiat Oncol Biol Phys 78:1064-1072, 2010 – reference: 4) 鮫島伸一, 澤田俊夫, 長廻 鉱:本邦における肛門扁平上皮癌, 痔瘻癌の現況, 第59回大腸癌研究会アンケート調査報告. 日本大腸肛門病会誌 58:415-421, 2005 – reference: 3) National Comprehensive Cancer Network: Anal carcinoma. Version 1. 2022. https://www.nccn.org/professionals/physician_gls/pdf/anal.pdf. Accessed May 11, 2022. – reference: 8) 松田圭二, 八木貴博, 塚本充雄ほか:肛門管悪性 腫瘍の臨床的特徴と治療方針. 胃と腸 51:295-308, 2016 – reference: 13) Gunderson LL, Winter KA, Ajani JA, et al: Long-term update of US GI Intergroup RTOG 98-11. A phase III trial for anal carcinoma: survival, relapse, and colostomy failure with concurrent chemoradiation involving fluorouracil/mitomicin, versus fluorouracil/cisplatin. J Clin Oncol 30:4344-4351, 2012 – reference: 20) 日本腎臓学会, 日本癌治療学会, 日本臨床腫瘍学会ほか編:がん薬物療法時の腎機能診療ガイドライン2016. ライフサイエンス出版, 東京, 2016, p15-17 – reference: 6) 大腸癌研究会編:大腸癌取扱い規約, 改訂第9版版. 金原出版, 東京, 2018 – reference: 25) Allal AS, Laurencet FM, Reymond MA, et al: Effectiveness of surgical salvage therapy for patients with locally uncontrolled anal carcinoma after sphincter-conserving treatment. Cancer 86:405-409, 1999 – reference: 17) Glynne-Jones R, Meadows H, Wan S, et al: EXTRA-A multicenter phase II study of chemoradiation using a 5 days per week oral regimen of capecitabine and intravenous mitomycin C in ana cancer. Int J Radiat Oncol Biol Phys 72:119-126, 2008 |
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| Snippet | 目的：肛門部扁平上皮癌（SCC）に対する化学放射線療法（CRT）の治療効果を検討した．対象と方法：CRTが施行された肛門部SCC 15例を対象とし，その治療成績を後方視的に検討した．結果：全例が放射線治療を完遂しえたが，Grade... |
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| SubjectTerms | 予後 再発 扁平上皮癌 肛門癌 |
| Title | 肛門部扁平上皮癌に対する化学放射線療法の治療成績 |
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