Matsuo Yukinori
1 Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Technol Cancer Res Treat. 2018 Jan 1;17:1533033818798633. doi: 10.1177/1533033818798633.
The purpose of this review article was to summarize available data on the efficacy and safety of salvage radiotherapy for isolated local or regional recurrence after prior stereotactic body radiotherapy for lung cancer.
Studies were systematically searched on PubMed, following which suitable papers were selected. Reported outcomes and toxicities were qualitatively reviewed.
Nineteen papers, which were retrospective studies based on single institution experiences, were selected. Sixteen papers were on salvage radiotherapy for local tumor recurrence, and the remaining 3 papers evaluated radiotherapy for regional failures after stereotactic body radiotherapy for lung cancer. Patient cohorts in the selected papers seemed very frail with 2-year survival of 30% to 40% after the salvage. Local control was reported to be approximately 60% to 70%, which is worse than that after primary stereotactic body radiotherapy. Reported rates of toxicity grade 3 or worse were considered acceptable. Larger target volume and central tumor localization were suggested as risk factors for severe toxicities. Dosimetric data on patients having toxicities were found to help with considering dose constraints for organs at risk.
Based on data from a limited number of articles, salvage radiotherapy is a reasonable treatment option for select patients with local or regional tumor recurrence after prior stereotactic body radiotherapy for lung cancer. Optimal patient selection and dose prescription can be clarified with a larger study that include more data on experiences with salvage radiotherapy.
这篇综述文章的目的是总结关于肺癌立体定向体部放疗后孤立局部或区域复发的挽救性放疗的疗效和安全性的现有数据。
在PubMed上系统检索研究，随后选择合适的论文。对报告的结果和毒性进行定性综述。
选择了19篇基于单机构经验的回顾性研究论文。16篇论文是关于局部肿瘤复发的挽救性放疗，其余3篇论文评估了肺癌立体定向体部放疗后区域失败的放疗情况。所选论文中的患者队列似乎非常虚弱，挽救性放疗后2年生存率为30%至40%。据报道局部控制率约为60%至70%，这比初次立体定向体部放疗后的情况更差。报告的3级或更严重毒性发生率被认为是可接受的。较大的靶体积和肿瘤中央定位被认为是严重毒性的危险因素。发现有毒性患者的剂量学数据有助于考虑危及器官的剂量限制。
基于有限数量文章的数据，挽救性放疗是肺癌初次立体定向体部放疗后局部或区域肿瘤复发的特定患者的合理治疗选择。通过一项纳入更多挽救性放疗经验数据的更大规模研究，可以明确最佳的患者选择和剂量处方。
