Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Center for Cancer Research, National Cancer Institute, Building 37, Room 1142, Bethesda, MD, 20892, USA.
J Neurooncol. 2019 Dec;145(3):415-427. doi: 10.1007/s11060-019-03332-7. Epub 2019 Nov 15.
Many brain tumor patients suffer from radiation-induced toxicities. Chronotherapy is a treatment modality that utilizes circadian rhythms to optimize the effect on tumor while minimizing negative outcomes on healthy tissue. This review aims to systematically examine the literature on the application of a radiation chronotherapeutic for all cancers and determine the possible advantages of incorporating a circadian-based fixed time-of-day for radiotherapy into CNS cancers.
A systematic review of the literature was conducted in two electronic databases from inception to February 1, 2019. Primary research manuscripts were screened for those related to adult human subjects exposed to ionizing radiation using the chronotherapy technique.
Nine manuscripts were included in the review from 79 eligible articles. Three were prospective randomized trails and 6 were retrospective reviews. This survey revealed that overall survival and tumor control do not have consistent effects with only 60% and 55.5% of paper which included the variables having some significance, respectively. Treatment symptoms were the primary endpoint for both the prospective trials and were examined in 3 of the retrospective reviews; effects were observed in sensitive tissue for all 5 studies including mucosal linings and skin basal layer.
Existing literature suggests that the application of radiation chronotherapy may reduce negative symptom outcome within highly proliferative tissues. Further examination of radiation chronotherapy in well-designed prospective trials and studies in brain tumor patients are merited.
许多脑肿瘤患者患有放射性毒性。时间治疗学是一种利用昼夜节律来优化肿瘤疗效而使正常组织不良反应最小化的治疗方式。本综述旨在系统地研究所有癌症中应用放射时间治疗学的文献，并确定将基于昼夜节律的固定时间的放射治疗纳入中枢神经系统癌症中的可能优势。
从开始到 2019 年 2 月 1 日，在两个电子数据库中进行了系统的文献回顾。对使用时间治疗技术暴露于电离辐射的成人人类受试者的主要研究文献进行了筛选。
从 79 篇合格文章中，有 9 篇文章被纳入综述。其中 3 篇为前瞻性随机试验，6 篇为回顾性研究。这项调查表明，总生存和肿瘤控制没有一致的效果，只有 60%和 55.5%的论文包括了有一定意义的变量。治疗症状是前瞻性试验的主要终点，3 项回顾性研究也对其进行了检查；5 项研究均观察到在敏感组织中存在影响，包括黏膜内层和皮肤基底层。
现有文献表明，放射时间治疗学的应用可能会减少高增殖组织中的负面症状结果。值得进一步在精心设计的前瞻性试验和脑肿瘤患者研究中研究放射时间治疗学。
