Campitelli Maura, Lazzari Roberta, Piccolo Federica, Ferrazza Patrizia, Marsella Anna Rita, Macchia Gabriella, Fodor Andrei, Santoni Riccardo, Tagliaferri Luca, Cerrotta Annamaria, Aristei Cynthia
Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Rome, Italy
Department of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milano, Lombardia, Italy.
Int J Gynecol Cancer. 2021 Sep;31(9):1278-1286. doi: 10.1136/ijgc-2020-002310. Epub 2021 Feb 25.
This review analyzes the experience and trends in external beam radiotherapy for delivering a boost in locally advanced cervical cancer, identifying whether radiation therapy modalities impact clinical outcomes with the ultimate aim of evaluating alternatives to brachytherapy. Three independent Italian radiation oncologists conducted a literature search on different external beam radiotherapy boost modalities in locally advanced cervical cancer. The search yielded 30 studies. Eight dosimetric studies, evaluating target coverage and dose to organs at risk, and nine clinical investigations, reporting clinical outcomes, were analyzed. Dosimetric studies comparing external beam radiotherapy boost with brachytherapy produced divergent results, while clinical studies were limited by their retrospective nature, heterogeneous doses, radiation schedules, volumes and techniques, diverse follow-up times, and small cohorts of patients. Evidence emerged that high-tech external beam radiotherapy seemed no better than image-guided brachytherapy for delivering a boost in locally advanced cervical cancer. Prospective clinical studies comparing high-tech external beam radiotherapy and image-guided brachytherapy should be encouraged.
本综述分析了局部晚期宫颈癌外照射放疗增敏的经验和趋势，确定放疗方式是否会影响临床结果，最终目的是评估近距离放疗的替代方案。三位意大利独立放射肿瘤学家对局部晚期宫颈癌不同的外照射放疗增敏方式进行了文献检索。检索得到30项研究。分析了8项评估靶区覆盖和危及器官剂量的剂量学研究，以及9项报告临床结果的临床研究。比较外照射放疗增敏与近距离放疗的剂量学研究结果不一，而临床研究受其回顾性性质、剂量异质性、放疗方案、体积和技术、不同的随访时间以及患者队列较小的限制。有证据表明，在局部晚期宫颈癌增敏方面，高科技外照射放疗似乎并不比影像引导近距离放疗更好。应鼓励开展比较高科技外照射放疗和影像引导近距离放疗的前瞻性临床研究。
