立体定向体部放疗治疗胰腺癌：最大限度控制肿瘤并减少并发症。
Maximizing Tumor Control and Limiting Complications With Stereotactic Body Radiation Therapy for Pancreatic Cancer.
机构信息
Department of Radiation Oncology, Geisinger Cancer Institute, Danville, Pennsylvania.
Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts.
出版信息
Int J Radiat Oncol Biol Phys. 2021 May 1;110(1):206-216. doi: 10.1016/j.ijrobp.2020.11.017. Epub 2020 Dec 24.
PURPOSE
Stereotactic body radiation therapy (SBRT) and stereotactic ablative body radiation therapy is being increasingly used for pancreatic cancer (PCa), particularly in patients with locally advanced and borderline resectable disease. A wide variety of dose fractionation schemes have been reported in the literature. This HyTEC review uses tumor control probability models to evaluate the comparative effectiveness of the various SBRT treatment regimens used in the treatment of patients with localized PCa.
METHODS AND MATERIALS
A PubMed search was performed to review the published literature on the use of hypofractionated SBRT (usually in 1-5 fractions) for PCa in various clinical scenarios (eg, preoperative [neoadjuvant], borderline resectable, and locally advanced PCa). The linear quadratic model with α/β= 10 Gy was used to address differences in fractionation. Logistic tumor control probability models were generated using maximum likelihood parameter fitting.
RESULTS
After converting to 3-fraction equivalent doses, the pooled reported data and associated models suggests that 1-year local control (LC) without surgery is ≈79% to 86% after the equivalent of 30 to 36 Gy in 3 fractions, showing a dose response in the range of 25 to 36 Gy, and decreasing to less than 70% 1-year LC at doses below 24 Gy in 3 fractions. The 33 Gy in 5 fraction regimen (Alliance A021501) corresponds to 28.2 Gy in 3 fractions, for which the HyTEC pooled model had 77% 1-year LC without surgery. Above an equivalent dose of 28 Gy in 3 fractions, with margin-negative resection the 1-year LC exceeded 90%.
CONCLUSIONS
Pooled analyses of reported tumor control probabilities for commonly used SBRT dose-fractionation schedules for PCa suggests a dose response. These findings should be viewed with caution given the challenges and limitations of this review. Additional data are needed to better understand the dose or fractionation-response of SBRT for PCa.
目的
立体定向体放射治疗（SBRT）和立体定向消融体放射治疗越来越多地用于胰腺癌（PCa），特别是在局部晚期和边界可切除疾病的患者中。文献中报道了多种剂量分割方案。本 HyTEC 综述使用肿瘤控制概率模型来评估用于治疗局部 PCa 患者的各种 SBRT 治疗方案的比较效果。
方法和材料
通过 PubMed 搜索，回顾了在各种临床情况下（如术前[新辅助]、边界可切除和局部晚期 PCa）使用少分割 SBRT（通常为 1-5 个分割）治疗 PCa 的已发表文献。使用α/β=10 Gy 的线性二次模型来解决分割差异。使用最大似然参数拟合生成逻辑肿瘤控制概率模型。
结果
转换为 3 个分割等效剂量后，汇总报告的数据和相关模型表明，在 3 个分割中相当于 30 至 36 Gy 的剂量下，未经手术的 1 年局部控制（LC）率约为 79%至 86%，在 25 至 36 Gy 的范围内显示出剂量反应，在 3 个分割中剂量低于 24 Gy 时，1 年 LC 低于 70%。5 个分割方案（Alliance A021501）中的 33 Gy 相当于 3 个分割中的 28.2 Gy，HyTEC 汇总模型中，未经手术的 1 年 LC 为 77%。在 3 个分割中的等效剂量高于 28 Gy 时，边缘阴性切除后的 1 年 LC 超过 90%。
结论
对 PCa 常用 SBRT 剂量分割方案的报告肿瘤控制概率的汇总分析表明存在剂量反应。鉴于本综述的挑战和局限性，应谨慎看待这些发现。需要更多的数据来更好地了解 SBRT 治疗 PCa 的剂量或分割反应。
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