Zhang Haidong, Jiang Tianxiang, Mu Mingchun, Zhao Zhou, Yin Xiaonan, Cai Zhaolun, Zhang Bo, Yin Yuan
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Gastrointestinal Surgery, Sanya People's Hospital, West China Sanya Hospital, Sichuan University, Sanya 572000, China.
Cancers (Basel). 2022 Jun 28;14(13):3169. doi: 10.3390/cancers14133169.
Gastrointestinal stromal tumors (GISTs) are considered insensitive to radiotherapy. However, a growing number of case reports and case series have shown that some lesions treated by radiotherapy achieved an objective response. The aim of the study was to perform a systematic review of all reported cases, case series, and clinical studies of GISTs treated with radiotherapy to reevaluate the role of radiotherapy in GISTs. A systematic search of the English-written literature was conducted using PubMed, Web of Science, and Embase databases. Overall, 41 articles describing 112 patients were retrieved. The included articles were of low to moderate quality. Bone was the most common site treated by radiotherapy, followed by the abdomen. In order to exclude the influence of effective tyrosine kinase inhibitors (TKIs), a subgroup analysis was conducted on whether and which TKIs were concurrently applied with radiotherapy. Results showed that radiotherapy alone or combined with resistant TKIs could help achieve objective response in selected patients with advanced or metastatic GISTs; however, survival benefits were not observed in the included studies. Pain was the most common symptom in symptomatic GISTs, followed by neurological dysfunction and bleeding. The symptom palliation rate was 78.6% after excluding the influence of effective TKIs. The adverse reactions were mainly graded 1-2. Radiotherapy was generally well-tolerated. Overall, radiotherapy may relieve symptoms for GIST patients with advanced or metastatic lesions and even help achieve objective response in selected patients without significantly reducing the quality of life. In addition to bone metastases, fixed abdominal lesions may be treated by radiotherapy. Publication bias and insufficient quality of included studies were the main limitations in this review. Further clinical studies are needed and justified.
胃肠道间质瘤（GISTs）被认为对放疗不敏感。然而，越来越多的病例报告和病例系列表明，一些接受放疗的病灶取得了客观缓解。本研究的目的是对所有报道的接受放疗的GISTs病例、病例系列和临床研究进行系统评价，以重新评估放疗在GISTs中的作用。使用PubMed、科学网和Embase数据库对英文文献进行了系统检索。总体而言，检索到41篇描述112例患者的文章。纳入的文章质量为低到中等。骨是接受放疗最常见的部位，其次是腹部。为了排除有效的酪氨酸激酶抑制剂（TKIs）的影响，对是否以及哪些TKIs与放疗同时应用进行了亚组分析。结果表明，单独放疗或联合耐药TKIs可帮助部分晚期或转移性GISTs患者获得客观缓解；然而，纳入研究中未观察到生存获益。疼痛是有症状的GISTs中最常见的症状，并伴有神经功能障碍和出血。排除有效TKIs的影响后，症状缓解率为78.6%。不良反应主要为1-2级。放疗总体耐受性良好。总体而言，放疗可缓解晚期或转移性病灶的GIST患者的症状，甚至可帮助部分患者获得客观缓解，且不会显著降低生活质量。除骨转移外，固定的腹部病灶也可接受放疗。发表偏倚和纳入研究质量不足是本综述的主要局限性。需要并值得进行进一步的临床研究。
