Department of Radiation Oncology, Olivia Newton-John Cancer Centre at Austin Health, Heidelberg 3084, Victoria, Australia.
Department of Surgery, Austin Health, Heidelberg 3084, Victoria, Australia.
World J Gastroenterol. 2022 Feb 21;28(7):745-754. doi: 10.3748/wjg.v28.i7.745.
BACKGROUND: Pancreatic cancer is a malignancy with one of the poorest prognoses amongst all cancers. Patients with unresectable tumours either receive palliative care or undergo various chemoradiotherapy regimens. Conventional techniques are often associated with acute gastrointestinal toxicities, as adjacent critical structures such as the duodenum ultimately limits delivered doses. Stereotactic body radiotherapy (SBRT) is an advanced radiation technique that delivers highly ablative radiation split into several fractions, with a steep dose fall-off outside target volumes. AIM: To discuss the latest data on SBRT and whether there is a role for magnetic resonance-guided techniques in multimodal management of locally advanced, unresectable pancreatic cancer. METHODS: We conducted a search on multiple large databases to collate the latest records on radiotherapy techniques used to treat pancreatic cancer. Out of 1229 total records retrieved from our search, 36 studies were included in this review. RESULTS: Studies indicate that SBRT is associated with improved clinical efficacy and toxicity profiles compared to conventional radiotherapy techniques. Further dose escalation to the tumour with SBRT is limited by the poor soft-tissue visualisation of computed tomography imaging during radiation planning and treatment delivery. Magnetic resonance-guided techniques have been introduced to improve imaging quality, enabling treatment plan adaptation and re-optimisation before delivering each fraction. CONCLUSION: Therefore, SBRT may lead to improved survival outcomes and safer toxicity profiles compared to conventional techniques, and the addition of magnetic resonance-guided techniques potentially allows dose escalation and conversion of unresectable tumours to operable cases.
背景:胰腺癌是所有癌症中预后最差的恶性肿瘤之一。对于无法切除的肿瘤患者,要么接受姑息治疗,要么接受各种化疗和放疗方案。传统技术通常与急性胃肠道毒性相关,因为十二指肠等邻近关键结构最终限制了所给予的剂量。立体定向体部放疗(SBRT)是一种先进的放疗技术,它将高剂量的放射线分成多个分次进行照射,在靶区外有陡峭的剂量下降。 目的:讨论 SBRT 的最新数据,以及磁共振引导技术在局部晚期不可切除胰腺癌的多模态治疗中的作用。 方法:我们在多个大型数据库中进行了检索,以收集用于治疗胰腺癌的放疗技术的最新记录。在我们的检索中总共检索到 1229 条记录,其中 36 项研究被纳入本综述。 结果:研究表明,与传统放疗技术相比,SBRT 具有改善的临床疗效和毒性特征。由于在放射治疗计划和治疗过程中,计算机断层扫描成像对软组织的可视化效果不佳,SBRT 进一步提高肿瘤剂量受到限制。磁共振引导技术已被引入以提高成像质量,从而能够在每次分次治疗前进行治疗计划的调整和重新优化。 结论:因此,与传统技术相比,SBRT 可能导致更好的生存结果和更安全的毒性特征,并且添加磁共振引导技术可能允许提高剂量并将不可切除的肿瘤转化为可切除的病例。
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