Introduction
To examine clinical outcomes and quality of life of patients with anal squamous cell carcinoma treated with interstitial pulsed-dose-rate brachytherapy (PDR-BT) with a boost to residual tumor after external radiotherapy.

Material and methods
Medical records of patients receiving a brachytherapy boost after radiotherapy for anal squamous cell carcinoma in our Institute between 2008 and 2019 were retrospectively reviewed. After receiving pelvic irradiation ± concurrent chemotherapy, patients received PDR-BT boost to residual tumor, in order to deliver a minimal total dose of 60 Gy. Patients’ outcomes were analyzed, with primary focus on local control, sphincter preservation, morbidity, and quality of life.

Results
A total of 42 patients were identified, included 24, 13, and 5 patients with I, II, and III tumor stages, respectively. Median brachytherapy (BT) dose was 20 Gy (range, 10-30 Gy). Median dose per pulse was 42 cGy (range, 37.5-50 cGy). With median follow-up of 60.4 months (range, 5.4-127.4 months), estimated local control and colostomy-free survival rates at 5 years were both 88.7% (95% CI: 67.4-96.4%). The largest axis of residual lesion after external beam radiation therapy (EBRT) and poor tumor shrinkage were associated with more frequent relapses (p = 0.02 and p = 0.007, respectively). Out of 40 patients with more than 6 months follow-up, only one experienced severe delayed toxicity (fecal incontinence). Health quality perception was very good or good in 20 of 22 (91%) patients, according to their replies of quality-of-life surveys. A total dose ≥ 63 Gy was associated with higher number of anorectal grade 1+ toxicities (n = 1.5 vs. n = 0.61, p = 0.02).

Conclusions
In this cohort of 42 patients with mainly I and II tumor stages, PDR-BT boost allowed for local control in 88.7% of patients, with only one grade 3 anorectal toxicity.



中文翻译：

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脉冲剂量率间质近距离放射治疗肛门鳞状细胞癌：临床结果和患者的健康质量感知

简介
旨在检查接受间质脉冲剂量率近距离放射治疗 (PDR-BT) 治疗的肛门鳞状细胞癌患者的临床结果和生活质量，并在外部放疗后增加残留肿瘤。

材料与方法
回顾性分析我院2008-2019年肛门鳞癌放疗后接受近距离放疗增强的患者病历。在接受盆腔照射±同步化疗后，患者接受 PDR-BT 加强对残留肿瘤，以提供 60 Gy 的最小总剂量。分析了患者的结局，主要关注局部控制、括约肌保留、发病率和生活质量。

结果
共确定了 42 名患者，分别包括 24 名、13 名和 5 名肿瘤分期为 I、II 和 III 期的患者。中位近距离放射治疗 (BT) 剂量为 20 Gy（范围，10-30 Gy）。每个脉冲的中位剂量为 42 cGy（范围，37.5-50 cGy）。中位随访时间为 60.4 个月（范围 5.4-127.4 个月），估计的 5 年局部控制和无结肠造口生存率均为 88.7%（95% CI：67.4-96.4%）。外束放射治疗 (EBRT) 后最大残留病灶轴和较差的肿瘤缩小与更频繁的复发相关（分别为 p = 0.02 和 p = 0.007）。在超过 6 个月随访的 40 名患者中，只有 1 名出现严重的延迟毒性（大便失禁）。根据他们对生活质量调查的答复，22 名患者中有 20 名 (91%) 的健康质量感知非常好或良好。

结论
在这组 42 名主要为 I 和 II 期肿瘤患者的队列中，PDR-BT 加强可在 88.7% 的患者中实现局部控制，仅出现 1 次 3 级肛门直肠毒性。