Oliinyk Dmytro, Augustin Teresa, Koehler Viktoria Florentine, Rauch Josefine, Belka Claus, Spitzweg Christine, Käsmann Lukas
Department of Radiotherapy and Radiation Oncology, University Hospital, LMU Munich, 81377 Munich, Germany.
Department of Internal Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany.
Cancers (Basel). 2020 Sep 3;12(9):2506. doi: 10.3390/cancers12092506.
Anaplastic thyroid carcinoma (ATC) is associated with a poor prognosis due to aggressive tumor growth and high treatment resistance. Hypofractionated treatment concepts may be more effective and less time consuming compared to normofractionated radiotherapy (RT). In this retrospective study, we aim to evaluate the outcome of hypofractionated regimens and perform a systematic review concerning hypofractionated RT and pooled analysis of this treatment modality. A systematic review using the MEDLINE/Pubmed and Cochrane databases was performed. Data from all eligible studies were extracted, and a pooled analysis of literature and our cohort ( = 60) was carried out to examine patient characteristics, toxicity, and outcomes of patients with ATC. As a result, median overall survival (OS) of the single center cohort was four (range 1-12) months. Survival rates at one, three, and six months were 82%, 55%, and 36%, respectively. In univariate analyses, multimodal treatment ( = 0.006) and gender ( = 0.04) were correlated with an improved OS. Six studies with a total number of 152 patients undergoing hypofractionated RT treatment were analyzed. The pooled analysis included four patient cohorts with 60 patients and showed median OS of 5.3 (range: 1-24) months. Multimodal treatment ( < 0.001) and a cumulative radiation dose ≥50 Gy in equivalent dose in 2 Gy fractions (EQD2) ( = 0.014) correlated with an improved OS. On multivariate analysis, multimodal treatment ( = 0.003, hazard ratio (HR): 0.636, 95% confidence interval (CI): 0.469-0.861) was an independent predictor for longer OS. After propensity score matching (PSM), hypofractionated RT appears to be non-inferior compared to normofractionated RT concerning OS. In conclusion, hypofractionated RT is effective with manageable toxicity. A dose escalation with ≥50 Gy (EQD2) correlated with a longer OS. Hypofractionated RT could be an integral part in multimodal treatment with a promising outcome.
间变性甲状腺癌（ATC）因肿瘤生长侵袭性强和治疗抵抗性高而预后较差。与常规分割放疗（RT）相比，大分割治疗方案可能更有效且耗时更少。在这项回顾性研究中，我们旨在评估大分割治疗方案的疗效，并对大分割RT进行系统评价及对该治疗方式进行汇总分析。我们使用MEDLINE/Pubmed和Cochrane数据库进行了系统评价。提取了所有符合条件研究的数据，并对文献和我们的队列（n = 60）进行汇总分析，以检查ATC患者的特征、毒性和疗效。结果，单中心队列的中位总生存期（OS）为4个月（范围1 - 12个月）。1个月、3个月和6个月的生存率分别为82%、55%和36%。在单因素分析中，多模式治疗（P = 0.006）和性别（P = 0.04）与OS改善相关。分析了6项研究，共有152例患者接受了大分割RT治疗。汇总分析纳入了4个患者队列共60例患者，显示中位OS为5.3个月（范围：1 - 24个月）。多模式治疗（P < 0.001）和等效剂量2 Gy分割下累积放疗剂量≥50 Gy（EQD2）（P = 0.014）与OS改善相关。在多因素分析中，多模式治疗（P = 0.003，风险比（HR）：0.636，95%置信区间（CI）：0.469 - 0.861）是OS延长的独立预测因素。倾向评分匹配（PSM）后，在OS方面，大分割RT似乎不劣于常规分割RT。总之，大分割RT有效且毒性可控。≥50 Gy（EQD2）的剂量递增与更长的OS相关。大分割RT可能是多模式治疗中不可或缺的一部分，预后前景良好。
