Seminars in Radiation Oncology最新文献

英文中文

Beyond Opioids in Pancreatic Cancer: Palliative Radiotherapy and Celiac Plexus Radiosurgery 胰腺癌中的阿片类药物：姑息性放疗和腹腔丛放射手术

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.005

Marcin Miszczyk , Ross A. Abrams , Yaacov R. Lawrence

This review examines established and evolving approaches for radiation therapy as a palliative treatment modality in patients with pancreatic cancer within the context of effective patient-provider communication and early palliative care team based management. At presentation most patients with pancreatic cancer have advanced disease and a limited life expectancy. Typically, they suffer from multiple disease-related symptoms. Systemic therapies have limited palliative efficacy against symptoms associated with local disease. This is in contrast to radiation therapy, which appears efficient in achieving local symptom control. In addition to more conventional tumour-targeting stereotactic body radiation therapy (SBRT), and short-course conventional radiotherapy, a recent clinical trial demonstrated the effectiveness of a new approach - celiac plexus radiosurgery. In this article, we evaluate and compare the effectiveness of these treatment methods, demonstrating the important, yet underappreciated, role that hypofractionated radiation therapy has within the multidisciplinary management of patients with pancreatic cancer, including those with metastatic disease.

本文综述了在有效的患者-提供者沟通和早期姑息治疗团队管理的背景下，胰腺癌患者放射治疗作为姑息治疗方式的既定和不断发展的方法。多数胰腺癌患者发病时病情已进展，预期寿命有限。通常，他们患有多种与疾病相关的症状。对于与局部疾病相关的症状，全身治疗的缓解效果有限。这与放射治疗相反，放射治疗似乎能有效地控制局部症状。除了更传统的肿瘤靶向立体定向放射治疗（SBRT）和短期常规放射治疗外，最近的一项临床试验证明了一种新方法的有效性-腹腔丛放射手术。在本文中，我们评估和比较了这些治疗方法的有效性，证明了低分割放疗在胰腺癌患者（包括转移性疾病患者）的多学科治疗中的重要作用，但未被充分认识。

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引用次数: 0

Quality and Quantity: Dual Benefits of Ablative Radiation in Oligometastatic Pancreatic Cancer 质与量：消融放疗治疗少转移性胰腺癌的双重益处

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.004

Todd A. Aguilera , Ahmed M. Elamir , Ethan B. Ludmir

Oligometastatic pancreatic cancer (OPanc) poses significant opportunities in management, as increasingly metastases can be safely and effectively targeted with local therapy. We review the existing literature on SABR for OPanc, highlighting its potential benefits and limitations with an aim to define the trajectory of opportunity. SABR may offer a meaningful benefit to patients with OPanc, improving quality of life by enabling breaks from systemic therapy while potentially enhancing quantity of life or survival. Patient selection and clearly defined goals will be critical to demonstrate the value of this approach, and well powered prospective studies may be key. The most intriguing aspect of this discussion is the potential for SABR to enhance antitumor immunity that may play a role in prolonged minimal residual disease that can be achieved in some patients. This can translate to improved quality of life by reducing the need for systemic therapy. This approach may offer a novel solution to the treatment challenges associated with OPanc. Further research is needed to confirm the hypotheses and establish the definitive role of SABR in OPanc treatment.

少转移性胰腺癌（OPanc）在治疗中提供了重要的机会，因为越来越多的转移可以安全有效地靶向局部治疗。我们回顾了现有的关于OPanc SABR的文献，强调了其潜在的好处和局限性，目的是确定机会的轨迹。SABR可能为OPanc患者提供有意义的益处，通过中断全身治疗来改善生活质量，同时潜在地增加生命或生存期。患者选择和明确定义的目标对于证明这种方法的价值至关重要，而强有力的前瞻性研究可能是关键。这个讨论中最有趣的方面是SABR增强抗肿瘤免疫的潜力，这可能在一些患者中实现的延长的最小残留疾病中发挥作用。这可以通过减少对全身治疗的需求来改善生活质量。这种方法可能为与OPanc相关的治疗挑战提供一种新的解决方案。需要进一步的研究来证实这些假设，并确定SABR在OPanc治疗中的明确作用。

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引用次数: 0

Clinical Applications of Quantitative Imaging and Artificial Intelligence for Pancreatic Cance 胰腺癌定量成像与人工智能的临床应用

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.003

Yeseul Kim , David Martinus , Taydan T. Tran , Michael K. Rooney , Anya Pant , Rance B. Tino , Eugene J. Koay

Pancreatic cancer remains as a leading cause of cancer death in the United States due to the disease’s deadly combination of evasiveness to detection, aggressive biology, and resistance to treatment. Quantitative imaging and artificial intelligence (AI) methods are emerging as promising and innovative techniques to combat the extensive challenges facing the clinic in the diagnosis and treatment of pancreatic ductal adenocarcinoma. These methods extract data from the fabric of clinical images that allow for earlier diagnosis, improved prognostication, automation of treatment planning, and increased reliability for response assessment. This review examines quantitative imaging techniques from 2013 to 2025 and summarizes them into three parts: differential diagnosis for pancreatic disease, grading and staging of pancreatic tumors, and treatment response assessment and prognosis prediction. We outline key challenges specific to pancreatic cancer and potential mitigations for future direction. We also highlight developing areas such as MRI-guided adaptive radiotherapy, automated target delineation, and integrated radiomic-omics tools that may help incorporate quantitative imaging into routine care of pancreatic cancer. Altogether, the current investigation suggests that quantitative imaging will become an integral tool for this disease across the oncologic journey of a patient.

在美国，胰腺癌仍然是癌症死亡的主要原因，这是由于这种疾病的致命组合，难以被发现，具有侵袭性的生物学和对治疗的耐药性。定量成像和人工智能（AI）方法正在成为有前途的创新技术，以应对临床在胰腺导管腺癌的诊断和治疗中面临的广泛挑战。这些方法从临床图像结构中提取数据，从而实现早期诊断，改善预后，自动化治疗计划，并提高反应评估的可靠性。本文回顾了2013年至2025年的定量影像学技术，并将其归纳为胰腺疾病的鉴别诊断、胰腺肿瘤的分级与分期、治疗反应评估与预后预测三个部分。我们概述了胰腺癌特有的关键挑战和未来方向的潜在缓解措施。我们还强调了mri引导的自适应放疗、自动靶标描绘和集成放射组学工具等发展领域，这些工具可能有助于将定量成像纳入胰腺癌的常规护理中。总之，目前的研究表明，定量成像将成为该疾病在患者整个肿瘤过程中的一个不可或缺的工具。

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引用次数: 0

Moving Beyond the Standard Pancreatectomy for Pancreatic Adenocarcinoma 超越标准胰腺切除术治疗胰腺腺癌

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.08.001

Madeleine D. Hunter , Nupur Shridhar , Kate Mlouk , Brian Kaplan , Greg D. Sacks , Christopher L. Wolfgang , Michael D. Kluger

This manuscript describes the evolution in the operative management of pancreatic cancer. Early attempts at pancreatic resection were met with daunting peri‑operative outcomes but were fine-tuned to yield today’s established pancreatic resections. Advances in medical therapy, including neo-adjuvant therapy for borderline resectable pancreatic cancers and refined adjuvant regimens, have improved oncologic outcomes and are allowing surgeons to move beyond current anatomic distinctions of resectability. Venous, hepatic artery and celiac axis resection during pancreatectomy are now common vascular operations at specialty centers which have been associated with favorable oncologic outcomes. Recent efforts are addressing locally advanced pancreatic cancer with superior mesenteric artery and/or multivessel involvement using either arterial divestment or arterial resection and reconstruction. An additional consideration in the treatment of pancreatic cancer is the benefit and risks of neoadjuvant radiation in locally advanced cases which has been avoided thus far given concerns regarding the effect of radiation on the vasculature. Therefore, with these improvements in peri‑operative therapy and robust preoperative planning often with the aid of vascular and microvascular surgeons, several centers have been exploring new frontiers in the operative management of locally advanced pancreatic adenocarcinoma.

本文描述了胰腺癌手术治疗的进展。早期胰腺切除术的尝试在围手术期的结果令人生畏，但经过微调后，今天已经建立了胰腺切除术。医学治疗的进步，包括边缘可切除胰腺癌的新辅助治疗和精细辅助方案，改善了肿瘤预后，并使外科医生能够超越目前可切除性的解剖差异。在胰腺切除术中进行静脉、肝动脉和腹腔轴切除是目前专业中心常见的血管手术，具有良好的肿瘤预后。最近的努力是解决局部晚期胰腺癌与肠系膜上动脉和/或多血管累及，无论是动脉剥离或动脉切除和重建。胰腺癌治疗的另一个考虑因素是局部晚期病例新辅助放疗的益处和风险，由于考虑到放疗对脉管系统的影响，迄今为止一直避免新辅助放疗。因此，在血管和微血管外科医生的帮助下，随着围手术期治疗的改进和完善的术前计划，一些中心已经在局部晚期胰腺腺癌的手术治疗中探索了新的领域。

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引用次数: 0

Contemporary Advances, Evidence, and Considerations in Preoperative Therapy for Pancreatic Ductal Adenocarcinoma 胰腺导管腺癌术前治疗的当代进展、证据和考虑

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.007

Alexander D. Sherry MD , Alexandra K. Bennett MD , Ryan M. Carr MD, PhD , Mark J. Truty MD, MS , Krishan R. Jethwa MD

Localized pancreatic ductal adenocarcinoma (PDAC) has been historically associated with poor disease control outcomes following surgical resection alone. Due to the high risk of occult locoregional and distant metastatic disease and anatomic tumor complexity limiting margin-negative resectability, preoperative therapy has emerged as an appealing strategy for many patients across the spectrum of localized PDAC. Here, we critically review the context, evidence, and controversies regarding preoperative therapy for PDAC. We first discuss the natural history of PDAC, patterns of spread and postoperative therapy. We then consider current issues of resectability, patient selection, therapy sequencing, and specifically the role of radiation therapy, including chemoradiation and stereotactic body radiation therapy, in the preoperative paradigm respectively. We conclude by discussing ongoing trials attempting to provide further insights and illuminating the path towards the improvement of outcomes in this patient population.

局限性胰腺导管腺癌（PDAC）历来与单纯手术切除后疾病控制效果差有关。由于隐蔽性局部和远处转移性疾病的高风险以及肿瘤的解剖复杂性限制了边缘阴性的可切除性，术前治疗已成为许多局限性PDAC患者的一种有吸引力的策略。在这里，我们批判性地回顾了关于术前治疗PDAC的背景、证据和争议。我们首先讨论PDAC的自然历史、扩散模式和术后治疗。然后，我们考虑当前的可切除性，患者选择，治疗顺序，特别是放射治疗的作用，包括放化疗和立体定向体放射治疗，分别在术前范例中。最后，我们讨论正在进行的试验，试图提供进一步的见解，并为改善这一患者群体的结果指明道路。

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引用次数: 0

Definitive Radiotherapy for Locally Advanced Unresectable Pancreatic Cancer: Historical Review, Current State and Future Directions 局部晚期不可切除胰腺癌的明确放疗：历史回顾，现状和未来方向

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.002

Anjalika R. Kumar , Nina N. Sanford

Based on available Level 1 evidence, standard dose conventional chemoradiation does not improve survival in patients with locally advanced pancreas cancer (LAPC), thus chemotherapy remains the only widely accepted therapy. Yet prognosis remains poor, and despite the negative trial outcomes, most would contend that the addition of radiotherapy does confer benefit in a subset of patients with LAPC. This work reviews the published data, then discusses several key considerations for designing radiotherapy trials in LAPC including choosing clinically meaningful patient-centered endpoints, optimizing patient selection and standardizing target volume delineation. Lastly, we review several promising single arm studies on dose-escalated radiotherapy in LAPC which have paved the way for upcoming Phase III randomized trials assessing this strategy.

根据现有的一级证据，标准剂量的常规放化疗不能提高局部晚期胰腺癌（LAPC）患者的生存率，因此化疗仍然是唯一被广泛接受的治疗方法。然而，预后仍然很差，尽管试验结果消极，但大多数人认为放疗的增加确实会给一部分LAPC患者带来好处。本工作回顾了已发表的数据，然后讨论了在LAPC中设计放疗试验的几个关键考虑因素，包括选择临床有意义的以患者为中心的终点，优化患者选择和标准化靶体积描绘。最后，我们回顾了几项在LAPC中剂量递增放疗的有希望的单组研究，这些研究为即将到来的评估该策略的III期随机试验铺平了道路。

引用次数: 0

The Role of MR Guided Radiation Therapy in Pancreatic Cancer Treatment 磁共振引导放射治疗在胰腺癌治疗中的作用

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.08.002

Alden D’Souza , Shannon Jiang , Michael D Chuong , Hyun Kim

引用次数: 0

Novel biomarkers for guiding treatment for prostate cancer 指导前列腺癌治疗的新生物标志物

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.002

David D. Yang, Paul L. Nguyen

Risk stratification is a cornerstone of the clinical management of nonmetastatic prostate cancer. Conventional risk stratification has relied on clinical and pathologic variables, which allow for patients to be placed into risk groups that help guide prognostication and treatment recommendations. However, the performance of conventional risk stratification systems is suboptimal, leading to undertreatment for some patients and overtreatment (with potentially avoidable side-effects) for others. In recent years, a number of novel biomarkers, with potential to significantly advance risk stratification, have appeared, including molecular, imaging, and digital pathology biomarkers. This review summarizes the technologies behind these novel biomarkers, their established clinical roles, challenges and limitations, and future directions.

风险分层是非转移性前列腺癌临床管理的基石。传统的风险分层依赖于临床和病理变量，允许将患者分为风险组，以帮助指导预后和治疗建议。然而，传统的风险分层系统的表现并不理想，导致一些患者治疗不足，而另一些患者治疗过度（可能有可避免的副作用）。近年来，出现了许多具有显著推进风险分层潜力的新型生物标志物，包括分子、成像和数字病理生物标志物。本文综述了这些新型生物标志物背后的技术、它们已确立的临床作用、挑战和局限性以及未来的发展方向。

引用次数: 0

The Use of Particle Therapy in Prostate Cancer 粒子疗法在前列腺癌中的应用

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.03.001

Abigail Pepin, Arun Goel, Neha Vapiwala

Prostate cancer represents the most common nonskin malignancy among males in the United States. There are a variety of treatment options for men with localized prostate cancer including surgery or radiation therapy. While recent advances in prostate cancer screening and treatment have improved prostate cancer outcomes, toxicity mitigation and attention to patient-related quality of life is critical. The employment of particle therapy may help us accomplish these objectives by allowing for increased dose escalation to tumor while lowering integral dose and improving dose distribution to organs at risk. Herein, we explore the use of particle bream radiotherapy for the treatment of prostate cancer and its evidence to date. More prospective data is needed on whether these therapies translate into clinically meaningful improvements in prostate cancer care, both from a quality of life and outcome perspective.

前列腺癌是美国男性中最常见的非皮肤恶性肿瘤。对于患有局限性前列腺癌的男性有多种治疗选择，包括手术或放射治疗。虽然前列腺癌筛查和治疗的最新进展改善了前列腺癌的预后，但毒性缓解和对患者相关生活质量的关注至关重要。粒子治疗的使用可以帮助我们实现这些目标，因为它允许增加肿瘤的剂量递增，同时降低整体剂量并改善危险器官的剂量分布。在此，我们探讨使用粒子鱼放射治疗前列腺癌及其证据到目前为止。从生活质量和预后的角度来看，这些疗法是否转化为前列腺癌治疗的临床有意义的改善，还需要更多的前瞻性数据。

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Postoperative Radiation Therapy and Controversies Regarding Hormonal Therapy in the Management of Prostate Cancer 前列腺癌术后放射治疗及激素治疗争议

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.009

Vérane Achard , Alan Dal Pra , Paul Sargos

Biochemical recurrence (BCR) after radical prostatectomy (RP) remains a clinical challenge, with significant heterogeneity in outcomes and optimal management strategies. Salvage radiotherapy (sRT) is the standard approach, yet the role and duration of concurrent hormonal therapy (ADT) are still debated. Four key randomized controlled trials—RTOG 9601, GETUG-AFU 16, RTOG 0534 SPPORT, and RADICALS-HD—have explored the addition of ADT to sRT. While ADT consistently improved progression-free survival metastasis-free survival (MFS) benefit was not consistently observed, and overall survival (OS) gains were limited and primarily confined to patients with higher pre-sRT PSA levels (>0.6-0.7 ng/mL). Toxicity associated with long-term ADT, including metabolic and cardiovascular effects, underscores the importance of patient selection. Emerging tools such as PSMA PET/CT and the Decipher genomic classifier show promise in refining risk stratification. PSMA PET/CT can identify occult metastases and guide treatment planning, while Decipher can help predict who may benefit from ADT. Retrospective and prospective data support their integration into clinical practice. Recent trials evaluating intensified systemic therapy with androgen receptor pathway inhibitors (ARPIs) in combination with sRT suggest potential benefit in high-risk BCR populations, although added toxicity remains a concern. The optimal role and timing of ARPIs in the early salvage setting require further investigation. In conclusion, the decision to add ADT to sRT in BCR patients should be individualized based on PSA kinetics, imaging, and genomic profiling. Shared decision-making and future biomarker-driven trials will be key to personalizing therapy and improving outcomes while minimizing harm.

根治性前列腺切除术（RP）后的生化复发（BCR）仍然是一个临床挑战，在结果和最佳管理策略方面存在显著的异质性。补救性放射治疗（sRT）是标准的方法，但同步激素治疗（ADT）的作用和持续时间仍有争议。四个关键的随机对照试验RTOG 9601、GETUG-AFU 16、RTOG 0534 SPPORT和radical - hd探讨了ADT在sRT中的添加。虽然ADT持续改善无进展生存期（MFS），但并没有一致观察到无转移生存期（MFS）的益处，而且总生存期（OS）的获益有限，主要局限于srt前PSA水平较高（0.6-0.7 ng/mL）的患者。与长期ADT相关的毒性，包括代谢和心血管影响，强调了患者选择的重要性。PSMA PET/CT和Decipher基因组分类器等新兴工具在细化风险分层方面表现出了希望。PSMA PET/CT可以识别隐匿性转移并指导治疗计划，而Decipher可以帮助预测谁可能从ADT中受益。回顾性和前瞻性数据支持其融入临床实践。最近评估雄激素受体途径抑制剂（arpi）联合sRT强化全身治疗的试验表明，尽管增加的毒性仍然是一个问题，但对高危BCR人群有潜在的益处。arpi在早期救助环境中的最佳作用和时机需要进一步研究。总之，BCR患者在sRT中加入ADT的决定应根据PSA动力学、影像学和基因组谱进行个体化。共享决策和未来生物标志物驱动的试验将是个性化治疗和改善结果的关键，同时将危害降到最低。

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