Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.
Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.
Clin Oncol (R Coll Radiol). 2018 Jul;30(7):400-408. doi: 10.1016/j.clon.2018.03.006. Epub 2018 Mar 31.
External beam radiotherapy (EBRT) is infrequently used to treat gastroenteropancreatic neuroendocrine tumours (GEPNETS), with little published data to date. We carried out a systematic review to assess the activity of EBRT for GEPNETS.
Major databases were searched for papers including at least five patients treated with contemporary EBRT techniques. Eligible studies underwent dual independent review. The primary end points were response rate for lesions treated with definitive intent and recurrence-free survival for primary lesions treated with neoadjuvant or adjuvant intent.
Of 11 included studies (all retrospective), seven investigated pancreatic neuroendocrine tumours (PNETs, 100 patients, 14% grade 3) and four studies investigated extra-pancreatic neuroendocrine tumours (84 patients, 14% grade 3). Trials investigating PNETs administered a median of 50.4 Gy via three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. EBRT was given with neoadjuvant or adjuvant intent in 56 patients, with a recurrence rate of 15%. For the 44 patients not undergoing surgery, the radiological response rate was 46%. Grade 3 + toxicity rates were 11% (acute) and 4% (late). Twelve patients with anorectal neuroendocrine carcinoma received 58 Gy to the primary tumour. Seventy-two patients were treated to sites of metastatic disease (34 bone, 27 brain, 11 soft tissue). Local and distant control were poorly reported. Overall survival ranged from 9 to 19 months. No studies in this group reported toxicity outcomes.
There are limited, retrospective data on the overall activity and safety of EBRT in GEPNETS. EBRT generally seems to be well tolerated in selected PNET patients with encouraging activity. Well-designed prospective studies in clearly defined populations are required to clarify the role of EBRT in neuroendocrine tumours.
外照射放疗（EBRT）很少用于治疗胃肠胰神经内分泌肿瘤（GEPNETS），目前发表的数据很少。我们进行了系统评价，以评估 EBRT 治疗 GEPNETS 的疗效。
主要数据库中搜索了至少包含 5 例接受现代 EBRT 技术治疗的患者的论文。合格的研究进行了双重独立审查。主要终点是明确意向治疗的病变的缓解率和新辅助或辅助意向治疗的原发性病变的无复发生存率。
11 项纳入研究（均为回顾性研究）中，有 7 项研究调查了胰腺神经内分泌肿瘤（PNET，100 例患者，14%为 3 级），4 项研究调查了胰腺外神经内分泌肿瘤（84 例患者，14%为 3 级）。研究 PNET 的试验采用三维适形放疗和调强放疗，中位数剂量为 50.4Gy。56 例患者接受新辅助或辅助 EBRT，复发率为 15%。对于未行手术的 44 例患者，影像学缓解率为 46%。3 级+毒性发生率为 11%（急性）和 4%（迟发性）。12 例肛门直肠神经内分泌癌患者接受原发肿瘤 58Gy 照射。72 例患者接受转移灶治疗（34 例骨转移，27 例脑转移，11 例软组织转移）。局部和远处控制情况报道不佳。总生存时间为 9 至 19 个月。该组中没有研究报告毒性结果。
胃肠胰神经内分泌肿瘤 EBRT 的总体疗效和安全性的相关数据有限，且多为回顾性研究。EBRT 似乎通常在有选择的 PNET 患者中耐受性良好，具有令人鼓舞的疗效。需要设计明确人群的前瞻性研究来阐明 EBRT 在神经内分泌肿瘤中的作用。
