Butala Anish A, Lo Simon S, Jones Joshua A
Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA.
Ann Palliat Med. 2019 Jul;8(3):337-351. doi: 10.21037/apm.2019.07.07.
Radiation Oncologists are involved in patient care from cancer diagnosis to the end of life, and 30-40% of radiation courses are delivered with palliative intent. Recent data has supported the use of advanced technology in select metastatic settings with respect to improvements in symptom response, local control, and even survival. Practicing physicians must thus be aware of the appropriate uses of advanced radiation techniques, especially with the development of life-prolonging targeted therapy and immunotherapies for individuals with advanced disease. As patients live longer with metastatic burden clinicians may increasingly encounter complex clinical scenarios that strike a 'middle ground' between purely palliative or curative intent. That is, the situation in which aggressive palliation is warranted to provide durable local control and potentially improve progression free and overall survival. This article is intended to provide a framework that clinicians can utilize when considering treatment options in complex palliative settings. The review begins with an introduction to advanced radiation techniques, their relevance with respect to histology, and the importance of dosing and fractionation. It further explores the data supporting the use of advanced techniques in the setting of brain metastases, lung metastases, non-spine bone metastases, spinal bone metastases, spinal cord compression, and liver metastases. Each of the sections also discusses specific site-related factors to consider that may sway a practitioner toward or against the use of such techniques. Where applicable, outcomes of re-irradiation are also discussed.
放射肿瘤学家参与从癌症诊断到生命终结的患者护理工作，30%-40%的放射治疗疗程是以姑息治疗为目的进行的。最近的数据支持在某些转移性疾病情况下使用先进技术，以改善症状反应、局部控制，甚至提高生存率。因此，执业医师必须了解先进放射技术的适当应用，特别是随着针对晚期疾病患者的延长生命的靶向治疗和免疫疗法的发展。随着患者在有转移负担的情况下存活时间延长，临床医生可能会越来越多地遇到介于纯粹姑息治疗意图或根治性意图之间的复杂临床情况。也就是说，需要积极的姑息治疗以提供持久的局部控制，并有可能改善无进展生存期和总生存期的情况。本文旨在提供一个框架，供临床医生在考虑复杂姑息治疗环境中的治疗选择时使用。综述首先介绍先进放射技术、它们与组织学的相关性以及剂量和分割的重要性。它进一步探讨了支持在脑转移、肺转移、非脊柱骨转移、脊柱骨转移、脊髓压迫和肝转移情况下使用先进技术的数据。每个部分还讨论了可能影响从业者决定是否使用此类技术的特定部位相关因素。在适用的情况下，还讨论了再程放疗的结果。
