Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy.
Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy.
Gynecol Oncol. 2023 Dec;179:33-41. doi: 10.1016/j.ygyno.2023.10.016. Epub 2023 Oct 30.
The aim of this study was to provide a literature review on the efficacy and safety of reirradiation(re-I) of locoregional recurrences in gynecological malignancies.
A computerized literature search was performed in 4 electronic databases (1993-2020). Random-effects models and a tendency towards high heterogeneity (Cochran Q chi-square test and the I statistic) were used. A meta-analysis technique over single and multi-arm studies was performed to determine the pooled acute and late toxicity rate ≥ G3, locoregional control (LC), and overall survival (OS).
Out of 178 articles, only 18 articles accounting for 820 patients (pts) met the inclusion criteria. Outcomes were evaluable for 522 patients. Subgroup analyses highlighted moderate to high heterogeneity among studies. BT (Brachytherapy) showed a 2y OS of 63% (95% CI, 55 to 71 p = 0,36) and 5y OS of 42% (95% CI, 35 to 50, p = 0,43) with 1y-2y-3y LC of 74 (95% CI, 62 to 75, p = 0.04)49% (95% CI, 40 to 58, p = 0.38) and 48% (95% CI, 39 to 58, p = 0,45) respectively. Chemotherapy does not improve SBRT outcomes: BT showed a G3- G4 toxicities rate was of26% (95% CI: 8-49%); studies on SBRT re-I showed a G3-G4 toxicity around of 20% if combined with CHT, and <10 when alone.
A large heterogeneity among studies was revealed, but showing promising results in terms of safety and feasibility. BT resulted the best kind of radiation therapy delivery in terms of clinical outcome and comparable to the SBRT technique in terms of toxicities.
本研究旨在对妇科恶性肿瘤局部区域复发再放疗(re-I)的疗效和安全性进行文献回顾。
在 4 个电子数据库（1993 年至 2020 年）中进行了计算机文献检索。使用随机效应模型和高度异质性趋势（Cochran Q 卡方检验和 I 统计量）。对单臂和多臂研究进行荟萃分析技术，以确定≥G3 级的急性和晚期毒性发生率、局部区域控制（LC）和总生存率（OS）的汇总率。
在 178 篇文章中，只有 18 篇文章（共 820 例患者）符合纳入标准。共有 522 例患者的结果可评估。亚组分析显示研究之间存在中度至高度异质性。BT（近距离放疗）显示 2 年 OS 为 63%（95%CI，55 至 71，p=0.36）和 5 年 OS 为 42%（95%CI，35 至 50，p=0.43），1 年-2 年-3 年 LC 率分别为 74%（95%CI，62 至 75，p=0.04）、49%（95%CI，40 至 58，p=0.38）和 48%（95%CI，39 至 58，p=0.45）。化疗不能提高 SBRT 结果：BT 显示 26%（95%CI：8-49%）的 G3-G4 毒性率；再放疗的 SBRT 研究显示，如果与 CHT 联合使用，G3-G4 毒性约为 20%，单独使用时则低于 10%。
研究之间存在较大的异质性，但在安全性和可行性方面显示出有希望的结果。BT 在临床结果方面是最好的放射治疗方式，与 SBRT 技术的毒性相当。
