疾病的局部控制和缓解率:高质量的证据显示,综合治疗 (CMT) 与单独放疗相比,可显著改善局部控制(3 年后为 61% vs 39%;[23]UKCCCR Anal Cancer Trial Working Party. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. Lancet. 1996;348:1049-1054.http://www.ncbi.nlm.nih.gov/pubmed/8874455?tool=bestpractice.com[24]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.http://www.ncbi.nlm.nih.gov/pubmed/20354531?tool=bestpractice.com5 年后为 68% vs 50%[25]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.http://www.ncbi.nlm.nih.gov/pubmed/9164216?tool=bestpractice.com)。该方法与单独放疗相比也可改善缓解率(80% vs 54%)。[25]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.http://www.ncbi.nlm.nih.gov/pubmed/9164216?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
疾病的局部控制和缓解率:高质量的证据显示,综合治疗 (CMT) 与单独放疗相比,可显著改善局部控制(3 年后为 61% vs 39%;[23]UKCCCR Anal Cancer Trial Working Party. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. Lancet. 1996;348:1049-1054.http://www.ncbi.nlm.nih.gov/pubmed/8874455?tool=bestpractice.com[24]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.http://www.ncbi.nlm.nih.gov/pubmed/20354531?tool=bestpractice.com5 年后为 68% vs 50%[25]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.http://www.ncbi.nlm.nih.gov/pubmed/9164216?tool=bestpractice.com)。该方法与单独放疗相比也可改善缓解率(80% vs 54%)。[25]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.http://www.ncbi.nlm.nih.gov/pubmed/9164216?tool=bestpractice.com
无结肠造口的生存率:高质量的证据显示,综合治疗 (CMT) 与单独放疗相比可显著改善无结肠造口术的生存率(72% vs 40%)。[25]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.http://www.ncbi.nlm.nih.gov/pubmed/9164216?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
无结肠造口的生存率:高质量的证据显示,综合治疗 (CMT) 与单独放疗相比可显著改善无结肠造口术的生存率(72% vs 40%)。[25]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.http://www.ncbi.nlm.nih.gov/pubmed/9164216?tool=bestpractice.com
无病生存率和无结肠造口的生存率:高质量的证据显示,与单独放疗+ 丝裂霉素相比,放疗 + 丝裂霉素 + 氟尿嘧啶可达到较高的无病生存率和无结肠造口术的生存率。[28]Flam M, John M, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and 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.http://www.ncbi.nlm.nih.gov/pubmed/8823332?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
无病生存率和无结肠造口的生存率:高质量的证据显示,与单独放疗+ 丝裂霉素相比,放疗 + 丝裂霉素 + 氟尿嘧啶可达到较高的无病生存率和无结肠造口术的生存率。[28]Flam M, John M, Pajak TF, et al. Role of mitomycin in combination with fluorouracil and radiotherapy, and 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.http://www.ncbi.nlm.nih.gov/pubmed/8823332?tool=bestpractice.com
调强放射治疗 (IMRT) 的应用可成功降低治疗毒性反应:中等质量证据显示,使用 IMRT 以降低急性和远期放疗相关毒副反应可取得良好结果,同时在平均随访 15 个月后,局部治疗反应为 84%,远处反应为 93%,无结肠造口的生存率为 84%,总生存率为 93%。[34]Salama JK, Mell LK, Schomas DA, et al. Concurrent chemotherapy and intensity-modulated radiation therapy for anal cancer patients: a multicenter experience. J Clin Oncol. 2007;25:4581-4586.http://ascopubs.org/doi/full/10.1200/jco.2007.12.0170http://www.ncbi.nlm.nih.gov/pubmed/17925552?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
调强放射治疗 (IMRT) 的应用可成功降低治疗毒性反应:中等质量证据显示,使用 IMRT 以降低急性和远期放疗相关毒副反应可取得良好结果,同时在平均随访 15 个月后,局部治疗反应为 84%,远处反应为 93%,无结肠造口的生存率为 84%,总生存率为 93%。[34]Salama JK, Mell LK, Schomas DA, et al. Concurrent chemotherapy and intensity-modulated radiation therapy for anal cancer patients: a multicenter experience. J Clin Oncol. 2007;25:4581-4586.http://ascopubs.org/doi/full/10.1200/jco.2007.12.0170http://www.ncbi.nlm.nih.gov/pubmed/17925552?tool=bestpractice.com