Willmann Jonas, Andratschke Nicolaus, Klußmann Jens Peter, Gschwend Jürgen E, Tabatabai Ghazaleh, Niyazi Maximilian
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany; Rechts der Isar Medical Center, Department of Urology, Technical University Munich, Munich, Germany; Department of Neurology and Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Center for Neuro-Oncology, Comprehensive Cancer Center, University Hospital Tübingen, Tubingen, Germany; Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Germany; Center for Neurooncology, Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany.
Dtsch Arztebl Int. 2024 Nov 1;121(22):725-732. doi: 10.3238/arztebl.m2024.0156.
The treatment options for patients with progressive malignant tumors despite primary radiotherapy are often limited. In selected cases, re-irradiation can be offered. This article concerns the selection criteria and results of re-irradiation for certain types of cancer.
This review is based on pertinent publications retrieved by a selective search in PubMed, with particular attention to glio - blastoma, head and neck tumors, and prostatic carcinoma.
The published studies of re-irradiation are few in number and often of limited methodological quality. For glioblastoma, a randomized controlled trial (RCT) found that adding re-irradiation to treatment with bevacizumab yielded no significant improvement in either median progression-free survival or median overall survival (hazard ratio [HR] 0.73; p = 0.05 and HR 0.98; p = 0.46, respec - tively). Re-irradiation is a treatment option for locoregional recurrences of head and neck tumors after primary radiotherapy, but it carries a risk of serious side effects. For unresectable recurrences of nasopharyngeal carcinoma, an RCT has shown that hyperfractionated re-irradiation is more effective than normofractionated re-irradiation (overall survival: HR 0.54, p = 0.014). For locally recurrent prostatic carcinoma after radiotherapy, re-irradiation can yield good oncologic outcomes with an acceptable level of urogenital and gastrointestinal side effects (5-year recurrence-free survival: stereotactic body radiation therapy (SBRT), 58%; high dose rate (HDR) brachytherapy, 77%; versus salvage prostatectomy, 72%). RCTs on this topic are lacking.
Re-irradiation is a treatment option for selected cancer patients. As the available scientific evidence is limited, multidisciplinary collaboration and participatory decision-making are particularly important.
尽管进行了原发性放射治疗，但进展期恶性肿瘤患者的治疗选择往往有限。在某些特定情况下，可以进行再程放疗。本文关注某些类型癌症再程放疗的选择标准及结果。
本综述基于在PubMed中通过选择性检索获得的相关出版物，特别关注胶质母细胞瘤、头颈部肿瘤和前列腺癌。
已发表的再程放疗研究数量较少，且方法学质量往往有限。对于胶质母细胞瘤，一项随机对照试验（RCT）发现，在贝伐单抗治疗基础上加用再程放疗，无论是中位无进展生存期还是中位总生存期均无显著改善（风险比[HR]分别为0.73；p = 0.05和HR 0.98；p = 0.46）。再程放疗是头颈部肿瘤原发性放疗后局部区域复发的一种治疗选择，但存在严重副作用的风险。对于不可切除的鼻咽癌复发，一项RCT表明，超分割再程放疗比常规分割再程放疗更有效（总生存期：HR 0.54，p = 0.014）。对于放疗后局部复发的前列腺癌，再程放疗可产生良好的肿瘤学结果，泌尿生殖系统和胃肠道副作用水平可接受（5年无复发生存率：立体定向体部放疗（SBRT）为58%；高剂量率（HDR）近距离放疗为77%；与挽救性前列腺切除术相比为72%）。缺乏关于该主题的RCT。
再程放疗是部分癌症患者的一种治疗选择。由于现有科学证据有限，多学科协作和参与式决策尤为重要。
