Bacorro Warren, Fionda Bruno, Soror Tamer, Bussu Francesco, Kovács György, Tagliaferri Luca
Department of Clinical Epidemiology, Faculty of Medicine and Surgery, University of Santo Tomas, 1008 Manila, Philippines.
Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, 1008 Manila, Philippines.
J Pers Med. 2024 Aug 11;14(8):853. doi: 10.3390/jpm14080853.
Peri-operative interventional radiotherapy (POIRT) entails tumor resection, catheter implantation in the same surgery, and irradiation within the peri-operative period. It allows for maximal tumor burden reduction, better tumor bed identification, more flexible implant geometry, highly conformal irradiation, and treatment delay minimization. We reviewed the published local control, survival, toxicity, and quality of life (QOL) outcomes with POIRT for head and neck cancers (HNCs) in primary and re-irradiation settings. A systematic search of PubMed, Scopus, Science Direct, and other databases, supplemented by bibliography scanning and hand-searching, yielded 107 titles. Fifteen unique articles were eligible, five of which were merged with more updated studies. Of the ten remaining studies, four reported on primary POIRT, and seven reported on reirradiation POIRT. Given data heterogeneity, only qualitative synthesis was performed. Primary POIRT in early tongue cancer results in 6-year recurrence-free (RFS) and overall survival (OS) of 92% for both; in advanced HNCs, the 9-year RFS and OS rates are 52% and 55%. Grade 1-2 toxicity is very common; grade 3-4 toxicity is rare, but grade 5 toxicity has been reported. POIRT re-irradiation for recurrent HNCs results in 5y RFS and OS rates of 37-55% and 17-50%; better outcomes are achieved with gross total resection (GTR). QOL data are lacking. Primary POIRT is safe and effective in early tongue cancers; its use in other HNC sites, especially in advanced disease, requires careful consideration. Re-irradiation POIRT is most effective and safe when combined with GTR; toxicity is significant and may be limited by careful case selection, implant planning and execution, use of smaller fraction sizes, and adherence to homogeneity constraints. PROSPERO Registry Number CRD42024548294.
围手术期介入放疗（POIRT）包括肿瘤切除、在同一手术中植入导管以及在围手术期内进行照射。它能够最大程度地减轻肿瘤负荷，更好地识别肿瘤床，使植入物几何形状更灵活，实现高度适形照射，并将治疗延迟降至最低。我们回顾了已发表的关于POIRT用于头颈部癌（HNC）的初次和再照射情况下的局部控制、生存、毒性及生活质量（QOL）结果。通过对PubMed、Scopus、Science Direct和其他数据库进行系统检索，并辅以文献扫描和手工检索，共获得107个标题。15篇独特的文章符合条件，其中5篇与更新的研究合并。在其余10项研究中，4项报道了初次POIRT，7项报道了再照射POIRT。鉴于数据的异质性，仅进行了定性综合分析。早期舌癌的初次POIRT导致6年无复发生存率（RFS）和总生存率（OS）均为92%；在晚期HNC中，9年RFS和OS率分别为52%和55%。1-2级毒性非常常见；3-4级毒性罕见，但有5级毒性的报道。复发性HNC的POIRT再照射导致5年RFS和OS率分别为37-55%和17-50%；全切除（GTR）可取得更好的结果。缺乏QOL数据。初次POIRT在早期舌癌中安全有效；在其他HNC部位使用，尤其是在晚期疾病中，需要仔细考虑。POIRT再照射与GTR联合时最有效且安全；毒性显著，可能通过仔细的病例选择、植入计划和实施、使用较小的分次剂量以及遵守均匀性限制来加以限制。PROSPERO注册号CRD42024548294。
