肿瘤电场治疗联合放疗治疗胶质母细胞瘤：一项叙述性综述。

Tumor treating fields with radiation for glioblastoma: a narrative review.

机构信息

Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.

出版信息

Chin Clin Oncol. 2022 Oct;11(5):40. doi: 10.21037/cco-22-90.

DOI:10.21037/cco-22-90

PMID:36336899

Abstract

BACKGROUND AND OBJECTIVE

With a phase 3 clinical trial (EF-32, ClinicalTrials.gov: NCT04471844) currently underway examining the potential benefit of concurrent chemoradiation and tumor treating fields (TTFields) for patients with glioblastoma (GBM), we present the following narrative review to highlight the current evidence that supports this approach. The current management paradigm for GBM includes maximal safe surgical resection followed by concurrent chemoradiation with further temozolomide (TMZ) and TTFields used as maintenance therapy. Despite several treatment advances over the past few decades, the overall prognosis remains poor and new strategies are currently under investigation, including the use of chemoradiation concurrently with TTFields.

METHODS

In this review, we will discuss the preclinical and clinical work that has been performed combining both TTFields with radiation. We performed a narrative review of peer-reviewed articles related to the management of glioblastoma with regard to concurrent chemoradiation and TTFields and synthesized the data in the context of our clinical experience and practice. PubMed, Medline, Embase, Cochrane Library, and various center-specific guidelines were searched for literature regarding concurrent chemoradiation with TTFields for patients with GBM.

KEY CONTENT AND FINDINGS

Driven by preclinical studies demonstrating the synergy between TTFields and radiation, more recent clinical work has been performed and has shown that combining treatment is both feasible and tolerable.

CONCLUSIONS

In this review, we will discuss the mechanism of action which TTFields and radiation share, as well as discuss the toxicities of combining therapy in patients with GBM. Based on institutional experiences, we will highlight treatment techniques, including scalp sparing methodology and modified computed tomography (CT) simulation workflow, when concurrent TTFields and radiation are given. Lastly, we will provide discuss management considerations, specifically scalp prophylactic interventions and treatments, when using concurrent TTFields with chemoradiation.

摘要

背景与目的

目前正在进行一项 3 期临床试验（EF-32，ClinicalTrials.gov：NCT04471844），旨在评估同步放化疗和肿瘤治疗电场（TTFields）联合应用于胶质母细胞瘤（GBM）患者的潜在获益，我们现将相关内容进行综述，以强调支持这种方法的现有证据。目前 GBM 的治疗模式包括最大限度的安全手术切除，随后进行同步放化疗，并用替莫唑胺（TMZ）和 TTFields 进行维持治疗。尽管过去几十年有了几项治疗进展，但总体预后仍然较差，目前正在研究新的策略，包括同步放化疗联合 TTFields 的应用。

方法

在本综述中，我们将讨论与 TTFields 联合应用于放疗相关的临床前和临床工作。我们对有关胶质母细胞瘤同步放化疗和 TTFields 管理的同行评议文献进行了叙述性综述，并根据我们的临床经验和实践对数据进行了综合。我们在 PubMed、Medline、Embase、Cochrane 图书馆以及各种中心特定指南中搜索了关于 GBM 患者同步放化疗联合 TTFields 的文献。

主要内容和发现

基于 TTFields 和放疗之间具有协同作用的临床前研究，最近进行了更多的临床工作，结果表明联合治疗是可行且可耐受的。

结论

在本综述中，我们将讨论 TTFields 和放疗共同作用的机制，并讨论在 GBM 患者中联合治疗的毒性。根据机构经验，我们将重点介绍治疗技术，包括头皮保护方法和改良 CT 模拟工作流程，在同步给予 TTFields 和放疗时。最后，我们将讨论管理注意事项，特别是在使用同步 TTFields 联合放化疗时的头皮预防性干预和治疗。