Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy; University of Brescia, Brescia, Italy.
Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy; Department of Oncology, University of Turin, Torino, Italy.
Lancet Oncol. 2017 Jul;18(7):e379-e393. doi: 10.1016/S1470-2045(17)30440-0.
Although the introduction of highly active antiretroviral therapy has radically improved the life expectancy of patients with HIV, HIV positivity is still considered a major barrier to oncological treatment for patients with cancer because of their worse prognosis and increased susceptibility to toxic effects compared with patients who are immunocompetent. The use of radiotherapy with or without chemotherapy, immunotherapy, or molecular targeted therapy is the standard of care for several cancers. These new drugs and substantial improvements in radiotherapy techniques, including intensity-modulated radiotherapy, image-guided radiotherapy, and stereotactic ablative radiotherapy, are optimising the feasibility of such anticancer treatments and are providing new opportunities for patients with cancer and HIV. In this Review, we discuss the role of radiotherapy, with or without chemotherapy or new drugs, in the treatment of cancer in patients with HIV, with a focus on the efficacy and tolerability of this approach on the basis of available evidence. Moreover, we analyse and discuss the biological basis of interactions between HIV and radiotherapy, evidence from preclinical studies, and immunomodulation by radiotherapy in the HIV setting.
虽然高效抗逆转录病毒疗法的引入极大地提高了 HIV 患者的预期寿命，但由于 HIV 阳性患者的预后更差，且比免疫功能正常的患者更容易受到毒性作用的影响，因此 HIV 阳性仍然被认为是癌症患者肿瘤治疗的主要障碍。放疗联合或不联合化疗、免疫疗法或分子靶向治疗是多种癌症的标准治疗方法。这些新药物以及放疗技术的实质性改进，包括强度调制放疗、图像引导放疗和立体定向消融放疗，正在优化这些抗癌治疗的可行性，并为 HIV 合并癌症患者提供新的机会。在这篇综述中，我们讨论了放疗（联合或不联合化疗或新药）在 HIV 合并癌症患者中的治疗作用，重点根据现有证据评估这种方法的疗效和耐受性。此外，我们还分析和讨论了 HIV 与放疗之间相互作用的生物学基础、临床前研究证据以及放疗在 HIV 背景下的免疫调节作用。
