Background: Although squamous cell carcinoma of the anus (SCCA) is a relatively uncommon malignancy in the United States, it continues to increase in incidence. Treatment for locoregional disease includes mitomycin and 5-fluorouracil with radiation. This combination is associated with significant toxicity, limiting its use in patients who are older or have certain comorbidities. Carboplatin and paclitaxel (C/P) is an accepted treatment regimen for metastatic SCCA. We aim to evaluate the efficacy and toxicity of weekly C/P given with radiation for patients unable to receive standard chemoradiation for SCCA. Methods: From our cancer registry, adult patients who received weekly intravenous C/P concurrent with standard-dose radiation for localized SCCA were included in this study. Clinical response was determined based on the evidence of disease on imaging and/or anoscopy. Toxicities were graded according to the CTCAE v5. Results: Ten patients were included; eight were female, and the median age was 75.5 years (54–87). Six had T2 disease, and four had T3 tumors. Four had node-positive disease. The majority (70%) of patients were dosed at standard C (AUC 2) and P (50 mg/m2), with a limited subset requiring dose reduction for baseline performance status. Patients completed a mean of 78.3% (40–100%) of the intended treatments. A total of 89% of the patients achieved a complete clinical response. With a median follow-up of 25.8 months (3.4–50.4 months), 67% of the patients are alive and without recurrence. Two patients have had local recurrence, and one patient had metastatic progression. The most common toxicities of any grade included leukopenia (100%), anemia (100%), radiation dermatitis (100%), diarrhea (100%), and fatigue (100%). Grade 3 or higher toxicities included neutropenic fever (20%), neutropenia (30%), and anemia (30%). Conclusions: This study demonstrates promising tolerability and efficacy for weekly C/P chemoradiation for patients with anal cancer unable to receive mitomycin and 5-fluorouracil. This regimen merits further investigation in prospective clinical trials.
背景：尽管肛门鳞状细胞癌（SCCA）在美国属于相对少见的恶性肿瘤，但其发病率持续上升。局部区域性疾病的标准治疗包括丝裂霉素联合5-氟尿嘧啶的同步放化疗方案，但该方案存在显著毒性，限制了其在老年或伴有特定合并症患者中的应用。卡铂联合紫杉醇（C/P）是转移性SCCA的公认治疗方案。本研究旨在评估无法接受标准放化疗的SCCA患者采用每周C/P方案联合放疗的疗效与毒性。 方法：通过癌症登记系统，本研究纳入了接受每周静脉注射C/P联合标准剂量放疗的局部进展期SCCA成年患者。临床疗效通过影像学和/或肛门镜检查评估。毒性反应依据CTCAE v5标准进行分级。 结果：共纳入10例患者，其中女性8例，中位年龄75.5岁（范围54-87岁）。6例为T2期病变，4例为T3期病变，4例伴有淋巴结转移。大多数患者（70%）接受标准剂量C（AUC 2）和P（50 mg/m²）治疗，少数患者因基线体能状态需要剂量调整。患者平均完成计划治疗量的78.3%（范围40-100%）。89%的患者获得完全临床缓解。中位随访25.8个月（范围3.4-50.4个月），67%的患者存活且无复发。2例出现局部复发，1例发生转移进展。所有级别中最常见的毒性反应包括白细胞减少（100%）、贫血（100%）、放射性皮炎（100%）、腹泻（100%）和疲劳（100%）。3级及以上毒性反应包括中性粒细胞减少性发热（20%）、中性粒细胞减少（30%）和贫血（30%）。 结论：本研究显示，对于无法接受丝裂霉素和5-氟尿嘧啶治疗的肛门癌患者，每周C/P方案同步放化疗具有较好的耐受性和疗效，值得在前瞻性临床试验中进一步验证。
肿瘤(癌症)患者之家