Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin,Campus Virchow-Klinikum; Charité CyberKnife Center Berlin, Charité-Universitätsmedizin Berlin,Campus Virchow-Klinikum; Klinik für Strahlentherapie Universitätsklinikum Leipzig; Department of Urology, Charité-Universitätsmedizin Berlin; Department of Otolaryngology, Charité-Universitätsmedizin Berlin,Campus Virchow-Klinikum.
Dtsch Arztebl Int. 2020 Mar 6;117(10):167-174. doi: 10.3238/arztebl.2020.0167.
Recent advances in diagnostic methods and in radiotherapy now increasingly enable repeat radiotherapy with curative intent for the treatment of previously irradiated lesions. In this review, we present data on oncological outcomes and on acute and late sequelae, as far as these are currently known, in patients with head and neck tumors (HNT) or prostate cancer (PCa) who underwent repeat radiotherapy after prior radiotherapy with curative intent.
This review is based on clinical series with over 20 patients that were published between May 1998 and April 2018 (HNT) or between October 1998 and October 2018 (PCa) and were retrieved by a search in the PubMed database.
Most of the clinical series retrieved were retrospective and uncontrolled. There were 16 studies that included 2678 patients with recurrent head and neck tumors, and 8 that included 245 patients with recurrent prostate cancer. In patients with squamous cell carcinoma of the head and neck, intensity-modulated radio - therapy (IMRT) and stereotactic body radiotherapy (SBRT) yielded three-year survival rates of 47-57% but also produced substantial acute and late adverse effects. Most of the studies concerning recurrent PCa involved small patient groups. In these studies, repeat radiotherapy with SBRT yielded tumor control rates of 40-80% after 11-24 months of follow-up, with only mild acute toxicity.
Although no comparative studies are available, it seems that modern external beam radiotherapy techniques can be used for repeat radiotherapy of locally recurrent head and neck tumors with curative intent after careful patient selection. Repeat radiotherapy of PCa must still be considered experimental, but initial results from small-scale trials are encouraging. The long-term adverse effects cannot yet be accessed. Patients should be selected by an interdisciplinary tumor board. This type of treatment is generally carried out in a specialized center.
近年来，诊断方法和放射治疗技术的进步使得对先前接受过放疗的病变进行重复放疗、以达到治愈目的的可能性日益增加。在本综述中，我们将介绍关于头颈部肿瘤（HNT）或前列腺癌（PCa）患者接受重复放疗后的肿瘤学结局，以及目前已知的急性和晚期并发症的数据，这些患者先前曾接受过治愈性放疗。
本综述基于 1998 年 5 月至 2018 年 4 月（HNT）或 1998 年 10 月至 2018 年 10 月期间发表的、超过 20 例患者的临床系列研究，检索数据库为 PubMed。
检索到的大多数临床系列研究均为回顾性和非对照性的。有 16 项研究纳入了 2678 例复发性头颈部肿瘤患者，8 项研究纳入了 245 例复发性前列腺癌患者。对于头颈部鳞状细胞癌患者，调强放疗（IMRT）和立体定向体部放疗（SBRT）的 3 年生存率为 47-57%，但也产生了大量的急性和晚期不良反应。大多数涉及复发性前列腺癌的研究涉及的患者群体较小。在这些研究中，SBRT 重复放疗在 11-24 个月的随访后，肿瘤控制率为 40-80%，仅有轻微的急性毒性。
尽管没有比较研究，但似乎可以对经过精心选择的患者，谨慎地使用现代外照射放疗技术对局部复发性头颈部肿瘤进行重复放疗、以达到治愈目的。前列腺癌的重复放疗仍需被视为实验性治疗，但小规模试验的初步结果令人鼓舞。目前还无法评估长期的不良反应。应由肿瘤多学科委员会选择患者。这种治疗方法通常在专门的中心进行。
