Département universitaire de radiothérapie, Centre Oscar Lambret, Lille, France.
Centre de recherche de l'Université de Montréal, (CRCHUM), Montréal, QC, Canada.
Radiother Oncol. 2021 Mar;156:1-9. doi: 10.1016/j.radonc.2020.10.033. Epub 2020 Nov 1.
Radiation therapy (RT) is an essential component of therapy either curative or palliative armamentarium in oncology, but its efficacy varies considerably among patients through many extrinsic and intrinsic mechanisms of the tumour, which are beginning to be better understood. Recent studies have shown that the gut microbiome represents a key factor in the modulation of the systemic immune response and consequently on patients' outcome. Moreover, the emergence of biomarkers that are derived from the gut microbiota has fuelled the development of adjuvant strategies for patients treated with immunotherapy in combination or not with RT. Despite progress in development of more precise radiotherapy techniques, almost all patients undergoing RT to the abdomen, pelvis, or rectum develop acute adverse events as a consequence of several dose-limiting parameters such as the location of irradiation that may subsequently damage normal tissue including the intestinal epithelium. Several lines of evidence in preclinical models identified that vancomycin improves RT-induced gastrointestinal toxicities such as diarrhea and oral mucositis. In order to gain further insight into this rapidly evolving field, we have systematically reviewed the studies that have described how the gut microbiome may directly or indirectly modulate RT efficacy and its gastro-intestinal toxicities. Lastly, we outline current knowledge gaps and discuss potentially more satisfactory therapeutic options to restore the functionality of the gut microbiome of patients treated with RT.
放射治疗（RT）是肿瘤学中治疗或姑息治疗手段的重要组成部分，但由于肿瘤的许多外在和内在机制，其疗效在患者之间存在很大差异，这些机制开始得到更好的理解。最近的研究表明，肠道微生物组代表了调节全身免疫反应的关键因素，因此也影响了患者的治疗结果。此外，源自肠道微生物组的生物标志物的出现，为接受免疫治疗联合或不联合 RT 治疗的患者的辅助治疗策略的发展提供了动力。尽管精确放疗技术的发展取得了进展，但几乎所有接受腹部、骨盆或直肠放疗的患者都会因几个剂量限制参数（如照射位置）而出现急性不良反应，这些参数可能随后会损害包括肠道上皮在内的正常组织。临床前模型中的多条证据表明，万古霉素可改善 RT 引起的胃肠道毒性，如腹泻和口腔粘膜炎。为了更深入地了解这一快速发展的领域，我们系统地回顾了描述肠道微生物组如何直接或间接地调节 RT 疗效及其胃肠道毒性的研究。最后，我们概述了当前的知识空白，并讨论了潜在的更令人满意的治疗选择，以恢复接受 RT 治疗的患者的肠道微生物组的功能。
