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Abstract: Radiochemotherapy is the main treatment for patients with squamous cell carcinoma of the anal canal. Anaemia is reported to have adverse effect on survival in cancer patients. The aim of the study was to evaluate the influence of anaemia on radiochemotherapy treatment outcome in patients with squamous cell carcinoma of the anal canal. Patients and methods. One hundred consecutive patients with histologically confirmed squamous cell carcinoma of the anal canal were treated radically with 3-dimensional conformal or intensity-modulated radiation therapy followed by brachytherapy or external beam radiotherapy boost and with concurrent mitomycin C and 5-fluorouracil. The influence on survival of pre-treatment, mean on-treatment and end-of-treatment haemoglobin (Hb) concentrations was studied. Results. The 5-year locoregional control, disease free survival, disease specific survival and overall survival rates for all patients were 72%, 71%, 77% and 62%, respectively. In univariate analysis, patients with pre-treatment and end-oftreatment Hb > 120 g/L survived statistically significantly better compared to patients with Hb % 120 g/L. Patients with mean on-treatment Hb > 120 g/L only had statistically significant better locoregional control and overall survival than patients with Hb % 120 g/L. In multivariate analysis, independent prognostic factors were pre-treatment Hb (> 120 g/L vs. % 120 g/L) for overall survival (hazard ratio [HR] = 0.419, 95% confidence interval [CI] = 0.190%0.927, p = 0.032) and stage (I & II vs. III) for disease specific (HR = 3.523, 95% CI = 1.375%9.026, p = 0.009) and overall survival (HR = 2.230, 95% CI = 1.167%4.264, p = 0.015). Conclusions. The pre-treatment, mean on-treatment and end-of-treatment Hb concentration > 120 g/L carried better prognosis for patients for with squamous cell carcinoma of the anal canal treated with radiochemotherapy. The pre-treatment Hb > 120 g/L was an independent prognostic factor for overall survival of patients with anal canal cancer.
Keywords: anaemia, anal canal squamous cell carcinoma, radiochemotherapy
Published in DiRROS: 30.04.2024; Views: 665; Downloads: 378
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Keywords: onkologija, rak dojke, kemoterapija
Published in DiRROS: 27.01.2023; Views: 1182; Downloads: 270
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Abstract: Uspešnost zdravljenja z radioterapijo (RT) je odvisna od številnih dejavnikov, med katerimi je tudi oksigenacija tumorskih celic. Tumorske celice, ki so dobro preskrbljene s kisikom, so namreč na obsevanje tudi do 3-krat bolj občutljive kot hipoksične tumorske celice. Poleg tega deluje hipoksija v tumorjih kot selekcijski pritisk, zaradi katerega preživijo le bolj maligne celice, z manjšim apoptotskim potencialom. V prisotnosti hipoksije se povečata genomska nestabilnost in metastatski potencial tumorskih celic, zveča pa se tudi odpornost celic na kemoterapijo, kar vse vpliva na uspešnost zdravljenja z RT. Hipoksija je posledica neskladja med celičnim dihanjem, koncentracijo kisika v krvi in perfuzijo tumorja, pri čemer so najpogostejši patogenetski mehanizmi neustrezna ožiljenost, motena difuzija kisika ter anemija, ki je lahko posledica rakave bolezni ali zdravljenja. Z uporabo invazivnih in novejših neinvazivnih diagnostičnih metod lahko ocenimo delež hipoksičnih celic v tumorju in temu prilagodimo terapevtski pristop. Boljši učinek obsevanja slabše oksigeniranih tumorjev lahko dosežemo z uporabo radiosenzibilizatorjev, z izboljšanjem tumorske oksigenacije, s selektivnim uničenjem hipoksičnih celic s citotoksini ter z obsevanjem hipoksičnih predelov z višjimi obsevalnimi odmerki ob pomoči radioprotektorjev in z uporabo sodobnih obsevalnih tehnik.
Keywords: hipoksija, oksigenacija tumorskih celic, radioterapija, obsevanje
Published in DiRROS: 19.03.2018; Views: 4584; Downloads: 1181
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