Shouman Mohamed A, Fuchs Frederik, Walter Franziska, Corradini Stefanie, Westphalen C Benedikt, Vornhülz Marlies, Beyer Georg, Andrade Dorian, Belka Claus, Niyazi Maximilian, Rogowski Paul
Department of Radiation Oncology, University Hospital LMU, Munich, Germany.
Bavarian Cancer Research Center (BZKF), Munich, Germany.
Clin Transl Radiat Oncol. 2024 Jan 28;45:100738. doi: 10.1016/j.ctro.2024.100738. eCollection 2024 Mar.
This systematic review aims to comprehensively summarize the current prospective evidence regarding Stereotactic Body Radiotherapy (SBRT) in various clinical contexts for pancreatic cancer including its use as neoadjuvant therapy for borderline resectable pancreatic cancer (BRPC), induction therapy for locally advanced pancreatic cancer (LAPC), salvage therapy for isolated local recurrence (ILR), adjuvant therapy after radical resection, and as a palliative treatment. Special attention is given to the application of magnetic resonance-guided radiotherapy (MRgRT).
Following PRISMA guidelines, a systematic review of the Medline database via PubMed was conducted focusing on prospective studies published within the past decade. Data were extracted concerning study characteristics, outcome measures, toxicity profiles, SBRT dosage and fractionation regimens, as well as additional systemic therapies.
31 studies with in total 1,571 patients were included in this review encompassing 14 studies for LAPC, 9 for neoadjuvant treatment, 2 for adjuvant treatment, 2 for ILR, with an additional 4 studies evaluating MRgRT. In LAPC, SBRT demonstrates encouraging results, characterized by favorable local control rates. Several studies even report conversion to resectable disease with substantial resection rates reaching 39%. The adoption of MRgRT may provide a solution to the challenge to deliver ablative doses while minimizing severe toxicities. In BRPC, select prospective studies combining preoperative ablative-dose SBRT with modern induction systemic therapies have achieved remarkable resection rates of up to 80%. MRgRT also holds potential in this context. Adjuvant SBRT does not appear to confer relevant advantages over chemotherapy. While prospective data for SBRT in ILR and for palliative pain relief are limited, they corroborate positive findings from retrospective studies.
本系统评价旨在全面总结立体定向体部放疗（SBRT）在胰腺癌各种临床情况下的当前前瞻性证据，包括其作为临界可切除胰腺癌（BRPC）的新辅助治疗、局部晚期胰腺癌（LAPC）的诱导治疗、孤立局部复发（ILR）的挽救治疗、根治性切除后的辅助治疗以及姑息治疗。特别关注磁共振引导放疗（MRgRT）的应用。
按照PRISMA指南，通过PubMed对Medline数据库进行系统评价，重点关注过去十年内发表的前瞻性研究。提取有关研究特征、结局指标、毒性特征、SBRT剂量和分割方案以及其他全身治疗的数据。
本评价纳入了31项研究，共1571例患者，其中14项研究针对LAPC，9项针对新辅助治疗，2项针对辅助治疗，2项针对ILR，另有4项研究评估MRgRT。在LAPC中，SBRT显示出令人鼓舞的结果，局部控制率良好。几项研究甚至报告转化为可切除疾病，实质性切除率达到39%。采用MRgRT可能为在尽量减少严重毒性的同时给予消融剂量的挑战提供解决方案。在BRPC中，一些将术前消融剂量SBRT与现代诱导全身治疗相结合的前瞻性研究取得了高达80%的显著切除率。MRgRT在此背景下也具有潜力。辅助SBRT似乎没有比化疗带来相关优势。虽然SBRT在ILR和姑息性疼痛缓解方面的前瞻性数据有限，但它们证实了回顾性研究的阳性结果。
