[胃肠道放射肿瘤学中改变实践的临床试验]。

IF 1.5 4区 医学 Q4 ONCOLOGY Cancer Radiotherapie Pub Date : 2024-11-01 DOI:10.1016/j.canrad.2024.09.004
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引用次数: 0

摘要

肿瘤放疗领域的最新进展以战略性试验的结果为标志,尤其是针对食道癌和直肠癌的试验。对于可切除的食管腺癌,ESOPEC 研究结果显示,与化学放疗(41.4Gy 放疗和卡铂/紫杉醇化疗)相比,氟尿嘧啶加白血病素、奥沙利铂和多西他赛的围手术期化疗可提高总生存率。在确诊情况下,CONCORDE 研究并未显示剂量升级有任何益处,标准剂量仍为 50Gy。对于可切除的胰腺癌,NRG/RTOG0848 研究比较了辅助化疗加或不加化疗放疗,发现在结节阴性患者亚组中,5 年无病生存率显著提高。在直肠癌方面,PRODIGE 23研究的7年更新证实,T3、T4或N+腺癌患者在化放疗前接受亚叶酸、氟尿嘧啶、伊立替康和奥沙利铂新辅助化疗可提高无病生存率和总生存率。OPRA 研究的更新版显示,与诱导化疗后再进行 CRT 相比,化放疗后再进行巩固化疗组的 5 年器官保留率明显更高。一项包括41名错配修复缺陷、局部晚期直肠癌患者的2期研究报告称,使用抗PDL1免疫疗法(dostarlimab)进行为期6个月的独家治疗可获得完全临床应答,无需进行其他治疗(既不放疗也不手术)。在肛门癌方面,对T1期或T2期小肿瘤患者的生存期和毒性情况进行了分析比较,具体取决于他们是接受了独家放疗还是化放疗。在放疗的基础上加用化疗对生存没有任何益处,但会显著增加毒性和放疗中断的风险。
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Études qui changent les pratiques en oncoradiothérapie digestive
Current events in radiotherapy oncology are marked by the results of strategic trials, particularly for esophageal and rectal cancers. For resectable esophageal adenocarcinoma, results of the ESOPEC study showed a benefit in overall survival from the perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin and docetaxel compared to chemoradiotherapy (41.4 Gy radiotherapy and carboplatin/paclitaxel chemotherapy). In definitive setting, the CONCORDE study did not show any benefit from dose escalation and the standard dose remains 50 Gy. For resectable pancreatic cancer, the NRG/RTOG0848 study that compared adjuvant chemotherapy with or without chemoradiotherapy found a significant increase of the 5-year disease-free survival rate in the subgroup of node-negative patients. For rectal cancers, the 7-year update of PRODIGE 23 study confirmed the benefit in disease-free- and overall survival of neoadjuvant folinic acid, fluorouracil, irinotecan and oxaliplatin chemotherapy before chemoradiotherapy of T3, T4 or N+ adenocarcinoma, while the update of the RAPIDO study revealed an unacceptable local recurrence rate in the experimental arm. The update of the OPRA study shows a significantly higher 5-year organ preservation rate in favor of the chemoradiotherapy arm followed by consolidation chemotherapy compared to induction chemotherapy followed by CRT. A phase 2 study, including 41 patients with mismatch repair deficient, locally advanced rectal cancer reported that exclusive treatment with anti-PDL1 immunotherapy (dostarlimab) for 6 months resulted in complete clinical response without the need of additional treatment (neither radiotherapy nor surgery). For anal carcinoma, the analysis of survival and toxicity profiles of patients treated for a small stage T1 or T2 tumor were compared depending on whether they received exclusive radiotherapy or chemoradiotherapy. The addition of chemotherapy to radiotherapy did not show any survival benefit but significantly increased toxicity and the risk of radiotherapy disruption.
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来源期刊
Cancer Radiotherapie
Cancer Radiotherapie 医学-核医学
CiteScore
2.20
自引率
23.10%
发文量
129
审稿时长
63 days
期刊介绍: Cancer/radiothérapie se veut d''abord et avant tout un organe francophone de publication des travaux de recherche en radiothérapie. La revue a pour objectif de diffuser les informations majeures sur les travaux de recherche en cancérologie et tout ce qui touche de près ou de loin au traitement du cancer par les radiations : technologie, radiophysique, radiobiologie et radiothérapie clinique.
期刊最新文献
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