Anal cancer is a rare malignancy with rising incidence. Definitive treatment with radiation and concurrent chemotherapy represent the standard of care for patients with non-metastatic disease. Advances in radiation delivery through the use of intensity-modulated radiotherapy have significantly reduced the toxic effects of treatment. Adaptive radiotherapy (ART) has emerged as a strategy to further enhance treatment precision and individualize therapy in response to patient-specific changes during the course of chemoradiotherapy. The rationale for ART in anal cancer stems from the recognition that significant anatomic and tumor changes can occur throughout the 5–6-week treatment course, including tumor shrinkage, weight loss, and variable rectal/bladder filling. This review discusses the role of ART in contemporary anal cancer management. We overview the principles of ART, delineate the technical workflows (including both computed tomography (CT) and MR-guided approaches), and examine how adaptive techniques are applied in treatment planning and delivery. We also review the clinical evidence to date, including dosimetric studies and emerging clinical trial data on ART in anal cancer, particularly its impact on outcomes and toxicity.
肛管癌是一种发病率逐渐上升的罕见恶性肿瘤。对于非转移性疾病患者，根治性放化疗是标准治疗方案。通过调强放疗实现的放射治疗技术进步，已显著降低了治疗毒性反应。适应性放疗作为一种新兴策略，能够根据患者在放化疗期间个体特异性变化进一步提升治疗精准度并实现个体化治疗。该策略在肛管癌中的应用基于以下认识：在为期5-6周的治疗过程中，患者可能发生显著的解剖结构和肿瘤变化，包括肿瘤体积缩小、体重下降及直肠/膀胱充盈状态改变等。本综述探讨适应性放疗在现代肛管癌治疗中的作用，系统阐述其基本原理，详细说明技术流程（包括CT引导和MR引导两种模式），并分析适应性技术如何应用于治疗计划制定与实施过程。同时，我们回顾了迄今为止的临床证据，包括剂量学研究及肛管癌适应性放疗的新兴临床试验数据，特别关注其对治疗效果和毒副反应的影响。
Optimizing Treatment Precision: Role of Adaptive Radiotherapy in Modern Anal Cancer Management
肿瘤(癌症)患者之家