局部复发性食管癌放疗的研究进展

食管癌在我国已经是最常见的消化道恶性肿瘤之一,食管癌治疗失败的原因主要是局部复发和未控,并且发现大部分患者在食管癌根治术后1～2年内复发。目前手术治疗、再程放疗、放化疗、靶向治疗等是食管癌治疗的主要手段,本文将对食管癌复发的因素及不同的放疗方式进行综述,进一步为局部复发性食管癌的治疗提供参考。     

Salvage treatments for locally recurrent nasopharyngeal cancer: Systematic review and meta-analysis

The present study aimed to evaluate the effectiveness and safety of various salvage treatments to treat locally recurrent nasopharyngeal carcinoma (IrNPC). A comprehensive search was conducted to gather relevant research publications on salvage treatment for IrNPC. Specifically, 2-, 3-, and 5-year overall survival were the primary outcome. A total of 89 studies with 101 cohorts were collected. Endoscopic nasopharyngectomy was found to be associated with a significantly improved 5-year OS compared with CRT (p = 0.027) and IMRT (p = 0.016). Moreover, based on recurrence T classification, the 2-, 3-, and 5-year OS were similar across different treatments. Endoscopic nasopharyngectomy was associated with a significant reduction in treatment-related complications (grade ≥ 3) compared with IMRT (p < 0.001) and open nasopharyngectomy (p = 0.028). Endoscopic nasopharyngectomy may provide comparable treatment outcomes to re-irradiation, while offering a better safety profile for selective patients with resectable IrNPC.     

Re-irradiation for Locally Recurrent Lung Cancer: Evidence,Risks and Benefits

In spite of recent improvements in both the technical delivery of radiotherapy and systemic therapy in the treatment of non-small cell lung cancer, local recurrence rates after radiotherapy remain a significant challenge. In the setting of local relapse after radiotherapy, treatments such as surgical resection or radiofrequency ablation are often not appropriate owing to disease and patient factors. Re-irradiation may be a potential treatment option. This overview considers the published evidence and potential treatment strategies.     

Re-irradiation in Paediatric Tumours of the Central Nervous System: National Guidelines from the Swedish Workgroup of Paediatric Radiotherapy

There is a lack of clinical protocols for re-irradiation in paediatric central nervous system (CNS) tumours. To fill this void, the Swedish Workgroup of Paediatric Radiotherapy (SBRTG) compiled national guidelines on re-irradiation in paediatric CNS tumours (diffuse intrinsic pontine glioma, ependymoma, germinoma and medulloblastoma). These have been in clinical practice since 2019 in all paediatric radiotherapy centres in Sweden. Since the implementation, the guidelines have been complemented with a yearly review on clinical outcome and toxicities in all paediatric patients treated according to the guidelines. This article presents the Swedish national guidelines on re-irradiation in paediatric CNS tumours.     

血清白蛋白水平与食管癌再程放疗预后关系的研究

目的:评估血清白蛋白水平在预测食管癌再程放疗预后中的价值.方法:收集病理学确诊的需要接受再程放疗的局部复发食管癌患者,放疗前行血清白蛋白检测,采用Kaplan-Meier法和Log-rank检验进行生存率计算,Cox回归模型分析预后影响因素.结果:血清白蛋白水平与分期有关(P=0.002),差异具有统计学意义(P ＜0.05);62例患者血清白蛋白高值组(≥35 g/L)的1、3、5年总生存率均高于低值组(＜35 g/L)(P =0.001),高值组的6个月和12个月的复发后生存率均高于低值组(P =0.026),以上差异均具有统计学意义(P＜0.05);血清白蛋白水平和复发时间是影响总生存时间的独立预后因素(P =0.015和P=0.000),差异具有统计学意义(P＜0.05).结论:食管癌再程放疗前行血清白蛋白检测对预测患者预后具有重要意义.     

Definitive re-irradiation using intensity-modulated radiation therapy in cancers of the head and neck,focusing on rare tumors

Purpose: To analyze the outcomes following re-irradiation for local recurrence of rare head and neck tumors.

Material and methods: We retrospectively analyzed 11 patients who had received intensity-modulated radiation therapy (IMRT) for recurrent tumors in the head and neck except for laryngopharynx.

Results: Primary tumor sites included the maxillary sinus, nasal cavity, and external ear canal in six, three, and two patients, respectively. The median follow-up times were 13 (range, 3–54) months. The median survival time was 17 months with 1- and 2-year survival rates of 63.64 and 39.77%, respectively. Among 11 patients, five experienced local failure in the follow-up period. The 1- and 2-year local control rates were 58 and 47%, respectively. Patients who had received a radiation dose of ≥3?Gy per fraction showed significantly better local control than those receiving less (p?=?.0419). One patient experienced Grade 3 facial pain as acute toxicity. Late toxicities included radiographic findings of partial central nervous system necrosis in three patients and Grade 3 osteonecrosis and Grade 3 facial nerve disorder in one patient.

Conclusions: Re-irradiation of rare head and neck tumors using IMRT for loco-regional recurrence may be an acceptable treatment option.     

局部复发性直肠癌再程外放疗研究进展

随着外放疗（EBRT）的进步,包括调强放疗和立体定向放疗的普及和质子、重离子放疗技术的应用,既往接受过盆腔放疗的局部复发性直肠癌（LRRC）病人再程EBRT的不良反应明显减少,其疗效也逐渐得到肯定。对于可切除性LRRC,应考虑术前或术中给予再程EBRT提高R0切除率、降低局部复发率;如无法手术,可以考虑再程EBRT姑息治疗。虽然放疗范围、剂量目前没有统一建议,但考虑到后期毒性反应,再程EBRT宜采用超分割模式。 【关键词】 局部复发性直肠癌;外放疗;再程放疗