Cancer Radiotherapie最新文献

英文中文

Réirradiation des récidives de carcinomes mammaires [复发性乳腺癌的再放射治疗]。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.012

Approximately 10 to 15% of patients with breast cancer will have a local recurrence after initial conservative treatment or mastectomy. Total mastectomy has historically been the standard treatment for local recurrence. However, the question of reirradiation may arise as part of a second conservative treatment in conjunction with segmentectomy or in the case of chest wall recurrence to improve local control. Different modalities are available: brachytherapy, external beam radiotherapy with or without hyperthermia. Although the carcinologic results are encouraging, this complex situation requires rigorous patient selection and technical requirements to achieve the best local control and limit toxicity events. This article presents a review of the literature on the different indications and techniques for reirradiation of ipsilateral recurrent breast cancer, with the aim of providing decision support in clinical practice.

大约有 10%至 15%的乳腺癌患者会在最初的保守治疗或乳房切除术后出现局部复发。全乳房切除术历来是治疗局部复发的标准方法。然而，作为第二次保守治疗的一部分，在分段切除术或胸壁复发的情况下，可能会出现再次照射以改善局部控制的问题。目前有多种不同的治疗方式：近距离放射治疗、体外放射治疗（含或不含热疗）。尽管癌变结果令人鼓舞，但这种复杂的情况需要严格的患者选择和技术要求，以实现最佳的局部控制并限制毒性事件。本文综述了同侧复发性乳腺癌再照射的不同适应症和技术，旨在为临床实践提供决策支持。

引用次数: 0

Salvage reirradiation for locally recurrent prostate cancer: A narrative review 局部复发前列腺癌的挽救性再照射：叙述性综述。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.008

In this narrative review, we will explore the different options for salvage re-irradiation for locally recurrent prostate cancer. Brachytherapy (BT) and stereotactic body radiation therapy (SBRT) appear to be successful options. We detailed doses, volumes, oncological outcomes, and toxicity events to identify the best salvage strategy. Salvage reirradiation can only be proposed in certain cases, depending on the patient and the clinical scenario. Specific imaging and tests are needed to safely deliver this treatment.

在这篇叙述性综述中，我们将探讨对局部复发性前列腺癌进行挽救性再照射的不同方案。近距离放射治疗（BT）和立体定向体放射治疗（SBRT）似乎是成功的选择。我们详细介绍了剂量、体积、肿瘤治疗效果和毒性事件，以确定最佳挽救策略。挽救性再照射只能在某些情况下提出，具体取决于患者和临床情况。要安全地进行这种治疗，需要进行特定的成像和检测。

引用次数: 0

Issue Contents 议题内容

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/S1278-3218(24)00176-8

引用次数: 0

Preoperative stereotactic radiotherapy for the management of brain metastases 治疗脑转移瘤的术前立体定向放射治疗。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.006

Traditionally, postoperative whole-brain radiation therapy (WBRT) has been used for resected brain metastases, reducing local and intracerebral relapses. However, WBRT is associated with cognitive deterioration. Postoperative stereotactic radiotherapy (SRT) has emerged due to its neurocognitive preservation benefits. Despite its advantages, postoperative SRT has several drawbacks, including difficulties in target volume delineation, increased risk of radionecrosis (RN) and leptomeningeal disease (LMD), and prolonged treatment duration. Preoperative SRT has been proposed as a potential alternative, offering promising results in retrospective studies. Retrospective studies have suggested that preoperative SRT could achieve high local control rates with fewer LMD and RN rates compared to postoperative SRT. However, preoperative SRT is primarily based on retrospective data, and no phase 2/3 trials have been published to date. Ongoing clinical trials are expected to provide further insights into the efficacy and safety of preoperative SRT, addressing key questions regarding fractionation, dose, and timing relative to surgery.

传统上，术后全脑放射治疗（WBRT）被用于切除的脑转移瘤，以减少局部和脑内复发。然而，WBRT 与认知功能退化有关。术后立体定向放射治疗（SRT）因其保留神经认知功能的优势而兴起。术后立体定向放射治疗虽然有其优点，但也存在一些缺点，包括靶体积难以确定、放射性坏死（RN）和脑外疾病（LMD）的风险增加以及治疗时间延长。术前 SRT 被认为是一种潜在的替代方法，在回顾性研究中取得了良好的效果。回顾性研究表明，与术后 SRT 相比，术前 SRT 可达到较高的局部控制率，LMD 和 RN 发生率较低。然而，术前 SRT 主要基于回顾性数据，迄今为止尚未公布任何 2/3 期试验。正在进行的临床试验有望进一步揭示术前 SRT 的疗效和安全性，解决与手术相关的分次、剂量和时机等关键问题。

引用次数: 0

Essais qui changent les pratiques : cancers urologiques [改变实践的试验：泌尿放射肿瘤学]。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.010

Herein, we provide a non-exhaustive selection of the main clinical trials presented in 2023–2024 related to radiation-oncology used in the treatment of urological cancers including prostate cancer (radiotherapy of localized prostate cancer, post-prostatectomy irradiation, reirradiation, biochemical recurrence following local treatment, radiotherapy for metastatic cancer), muscle invasive bladder cancer and primary kidney cancer.

在此，我们提供了 2023-2024 年期间公布的与放射肿瘤学用于治疗泌尿系统癌症（包括前列腺癌（局部前列腺癌的放射治疗、前列腺切除术后照射、再照射、局部治疗后的生化复发、转移癌的放射治疗））、肌浸润性膀胱癌和原发性肾癌有关的主要临床试验，但并非详尽无遗。

引用次数: 0

Artificial intelligence and radiotherapy: Evolution or revolution? 人工智能与放射治疗：进化还是革命？

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.09.003

The integration of artificial intelligence, particularly deep learning algorithms, into radiotherapy represents a transformative shift in the field, enhancing accuracy, efficiency, and personalized care. This paper explores the multifaceted impact of artificial intelligence on radiotherapy, the evolution of the roles of radiation oncologists and medical physicists, and the associated practical challenges. The adoption of artificial intelligence promises to revolutionize the profession by automating repetitive tasks, improving diagnostic precision, and enabling adaptive radiotherapy. However, it also introduces significant risks, such as automation bias, verification failures, and the potential erosion of clinical skills. Ethical considerations, such as maintaining patient autonomy and addressing biases in artificial intelligence systems, are critical to ensuring the responsible use of artificial intelligence. Continuous training and development of robust quality assurance programs are required to mitigate these risks and maximize the benefits of artificial intelligence in radiotherapy.

将人工智能，特别是深度学习算法，融入放射治疗是该领域的一次变革，可提高准确性、效率和个性化护理。本文探讨了人工智能对放射治疗的多方面影响、放射肿瘤学家和医学物理学家角色的演变以及相关的实际挑战。人工智能的应用有望通过自动化重复性任务、提高诊断精确度和实现自适应放疗来彻底改变这一行业。然而，它也带来了巨大的风险，如自动化偏差、验证失败以及临床技能的潜在削弱。要确保负责任地使用人工智能，道德方面的考虑至关重要，例如维护患者自主权和解决人工智能系统中的偏见问题。要降低这些风险，最大限度地发挥人工智能在放射治疗中的优势，就必须持续开展培训并制定强有力的质量保证计划。

引用次数: 0

Personalized strategies for brachytherapy of cervix cancer 宫颈癌近距离放射治疗的个性化策略。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.09.006

Among most tailored approaches in radiation oncology, the development of brachytherapy for the treatment of cervical cancer patients has benefited from various technological innovations. The development of 3D image-guided treatments was the first step for treatment personalization. This breakthrough preceded practice homogenization and validation of predictive dose and volume parameters and prognostic factors. We review some of the most significant strategies that emerged from the ongoing research in order to increase personalization in uterovaginal brachytherapy. A better stratification based on patients and tumors characteristics may lead to better discriminate candidates for intensification or de-escalation strategies, in order to still improve patient outcome while minimizing the risk of treatment-related side effects.

在放射肿瘤学的大多数定制方法中，用于治疗宫颈癌患者的近距离放射治疗的发展得益于各种技术创新。三维图像引导治疗的开发是个性化治疗的第一步。在这一突破之前，还进行了剂量和体积预测参数及预后因素的实践同质化和验证。为了提高子宫阴道近距离治疗的个性化程度，我们回顾了正在进行的研究中出现的一些最重要的策略。根据患者和肿瘤特征进行更好的分层，可以更好地区分强化或降级策略的候选者，从而在改善患者预后的同时最大限度地降低治疗相关副作用的风险。

引用次数: 0

Reirradiation of bone metastasis: A narrative review of the literature 骨转移瘤的再照射：文献综述

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.009

Patients with bone metastasis are prevalent among those receiving palliative radiotherapy (RT), with approximately 20 % requiring reirradiation (reirradiation). The goal of bone reirradiation may be local control (oligoreoccurrence or oligoprogression of a previously treated lesion or in a previous treatment field) or symptomatic (threatening or painful progression). Published data on bone reirradiation indicate almost two-thirds of overall pain response. The primary organ at risk (especially for spine treatment) is the spinal cord. The risk of radiation myelitis is < 1 % for cumulative doses of < 50 Gy. Intensity-modulated RT (IMRT) and stereotactic RT (SRT) appear to be safer than three-dimensional RT (3DRT), although randomized trials comparing these techniques in reirradiation are lacking. Reirradiation requires multidisciplinary assessment. Alternative treatments for bone metastases (surgery, interventional radiology, etc.) must be considered. Patients should have a performance status ≤ 2, with at least a 1-month interval between treatments. The planning process involves reviewing previous RT plans, cautious dose adjustments, and precise target delineation and dose distribution to minimize toxicity. Cumulative dosimetry, patient consent, and vigilant post-treatment monitoring and dose reporting are crucial.

在接受姑息放疗（RT）的患者中，骨转移患者占大多数，其中约 20% 需要再次放疗（reirradiation）。骨再照射的目的可能是局部控制（以前治疗过的病灶或以前治疗过的病灶的少复发或少进展），也可能是对症治疗（有威胁或疼痛的进展）。已公布的骨再照射数据显示，近三分之二的患者对总体疼痛有反应。有风险的主要器官（尤其是脊柱治疗）是脊髓。放射性脊髓炎的风险是

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引用次数: 0

Reirradiation of squamous cell carcinoma of the head and neck with external photons: A practical review of the literature 使用外部光子对头颈部鳞状细胞癌进行再照射：文献综述。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.011

The modalities of management by reirradiation for recurrence or a second localization of head and neck squamous cell carcinoma (HNSCC) in previously irradiated terrain is challenging due to the great heterogeneity of data in the literature, mainly retrospective data reporting non-negligible risks of serious late toxicity events. With the recent development of more precise and conformal radiotherapy techniques such as intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), stereotactic radiotherapy (SBRT), the benefit-to-risk ratio of reirradiation has evolved in recent years with encouraging results, but patient selection is crucial. The aim of this review is to discuss the role of HNSCC reirradiation in terms of patient selection and external photon radiotherapy techniques for definitive tumor reirradiation and postoperative reirradiation.

由于文献中的数据存在很大的异质性，主要是回顾性数据报告了不可忽视的严重晚期毒性事件风险，因此通过再照射治疗复发或二次定位的头颈部鳞状细胞癌（HNSCC）的方法极具挑战性。近年来，随着调强放疗（IMRT）、容积调强弧形放疗（VMAT）、立体定向放疗（SBRT）等更精确的适形放疗技术的发展，再照射的获益风险比也在不断提高，并取得了令人鼓舞的结果，但患者的选择至关重要。本综述旨在从患者选择、确定性肿瘤再照射和术后再照射的体外光子放疗技术等方面探讨 HNSCC 再照射的作用。

引用次数: 0

Brain metastases reirradiation 脑转移瘤再放射。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.09.005

The advances in cancer screening and therapies have allowed the improvement of metastatic patients’ survival, including those with brain metastases. This led to a substantial shift in brain metastases patients’ management for whom whole-brain radiation therapy, formerly widely used, has given way to a more focused management in which single- or multifractionated stereotactic radiation therapy now plays a predominant role. Although stereotactic radiation therapy offers excellent local control rates (70 to 90%), it does not prevent brain recurrence outside the radiation field, which is all the more frequent the higher the number of initial metastases and the longer the patient's survival. In the case of brain recurrence after irradiation, therapeutic options will depend both on the previous treatment and on the features of the recurrence. This article aims to review the available data on the efficacy and tolerability of various reirradiation schemes in different clinical situations.

癌症筛查和疗法的进步提高了包括脑转移患者在内的转移性癌症患者的生存率。这导致脑转移患者的治疗方法发生了重大转变，以前广泛使用的全脑放射治疗已让位于更集中的治疗方法，其中单次或多次分次立体定向放射治疗现在发挥着主导作用。虽然立体定向放射治疗的局部控制率非常高（70% 至 90%），但它并不能防止放射野外的脑部复发，而且这种情况越频繁，初始转移灶的数量就越多，患者的生存期就越长。在照射后脑复发的情况下，治疗方案将取决于先前的治疗和复发的特征。本文旨在回顾不同临床情况下各种再照射方案的疗效和耐受性方面的现有数据。

引用次数: 0

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