Angrisani A, Houben R, Marcuse F, Hochstenbag M, Maessen J, De Ruysscher D, Peeters S
Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands.
Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
Clin Transl Radiat Oncol. 2022 Mar 19;34:67-74. doi: 10.1016/j.ctro.2022.03.005. eCollection 2022 May.
Thymic epithelial tumors (TETs) are rare thoracic tumors, often requiring multimodal approaches. Surgery represents the first step of the treatment, possibly followed by adjuvant radiotherapy (RT) and, less frequently, chemotherapy. For unresectable tumors, a combination of chemotherapy and RT is often used. Currently, the optimal dose for patients undergoing radiation is not clearly defined. Current guidelines on RT are based on studies with a low level of evidence, where 2D RT was widely used. We aim to shed light on the optimal radiation dose for patients with TETs undergoing RT through a systematic review of the recent literature, including reports using modern RT techniques such as 3D-CRT, IMRT/VMAT, or proton-therapy. A comprehensive literature search of four databases was conducted following the PRISMA guidelines. Two investigators independently screened and reviewed the retrieved references. Reports with < 20 patients, 2D-RT use only, median follow-up time < 5 years, and reviews were excluded. Two studies fulfilled all the criteria and therefore were included. Loosening the follow-up time criteria to > 3 years, three additional studies could be evaluated. A total of 193 patients were analyzed, stratified for prognostic factors (histology, stage, and completeness of resection), and synthesized according to the synthesis without -analysis (SWIM) method. The paucity and heterogeneity of eligible studies led to controversial results. The optimal RT dose neither for postoperative, nor primary RT in the era of modern RT univocally emerged. Conversely, this overview can spark new evidence to define the optimal RT dose for each TETs category.
胸腺上皮肿瘤（TETs）是罕见的胸部肿瘤，通常需要多模式治疗方法。手术是治疗的第一步，可能随后进行辅助放疗（RT），化疗则较少使用。对于不可切除的肿瘤，常采用化疗和放疗联合的方法。目前，接受放疗患者的最佳剂量尚未明确界定。当前的放疗指南基于证据水平较低的研究，其中二维放疗被广泛应用。我们旨在通过对近期文献进行系统综述，包括使用三维适形放疗（3D-CRT）、调强放疗（IMRT）/容积调强弧形放疗（VMAT）或质子治疗等现代放疗技术的报告，来阐明接受放疗的TETs患者的最佳放疗剂量。按照系统评价和Meta分析的首选报告项目（PRISMA）指南，对四个数据库进行了全面的文献检索。两名研究者独立筛选并审查了检索到的参考文献。排除患者人数少于20例、仅使用二维放疗、中位随访时间少于5年的报告以及综述。两项研究符合所有标准，因此被纳入。将随访时间标准放宽至超过3年，另外三项研究也可进行评估。总共分析了193例患者，根据预后因素（组织学、分期和切除完整性）进行分层，并按照无分析综合（SWIM）方法进行综合分析。符合条件的研究数量稀少且存在异质性，导致结果存在争议。在现代放疗时代，无论是术后放疗还是初次放疗的最佳放疗剂量都尚未明确显现。相反，本综述可为确定每种TETs类型的最佳放疗剂量提供新的证据。
