背景:软组织肉瘤(STS)代表了一组不同的罕见恶性肿瘤。目前,术前5~6周放疗(RT)结合手术是治疗局部高级别肉瘤(G2-G3)的主要手段.越来越多的证据表明,通过低分割缩短术前RT疗程既不会增加毒性率也不会损害肿瘤学结果。相反,缩短RT疗程可以提高治疗依从性,提高成本效益,并为更广泛的患者提供更多的治疗机会。推测较高的不良反应发生率和较差的结果是对STS的低分割RT(HFRT)的担忧。本系统综述总结了术前HFRT治疗STS的当前证据,并讨论了与正常分割RT相比的毒性和肿瘤结局。
方法:我们对临床试验进行了系统评价,这些临床试验描述了使用PubMed,科克伦图书馆,Cochrane中央受控试验登记册,ClinicalTrials.gov,Embase,OvidMedline我们遵循了2020年系统评价和荟萃分析首选报告项目(PRISMA)指南。腹膜后肉瘤的试验,术后RT,并排除热疗。文章发表至11月30日,2021年,包括。
结果:初步搜索产生了94篇文章。删除重复和不合格的物品后,13篇有资格进行分析。回顾了8项II期试验和5项回顾性分析。大多数试验在高级别STS患者术前应用5×5Gy。与正常分割RT的历史试验相比,HFRT课程未显示不良事件发生率增加。毒性率与正常分级RT的试验相比大多相当或更低。此外,HFRT在治疗持续时间较短的情况下实现了相当的局部控制率。目前,超过15项关于HFRT+/-化疗的前瞻性研究正在进行中.
结论:回顾性数据和II期试验表明,术前HFRT是STS的合理治疗方式。肿瘤学结果和毒性特征是有利的。迄今为止,我们的知识主要来自第二阶段的数据。尚未发表比较STS中正常分割和HFRT的随机III期试验。多个正在进行的II期试验应用HFRT研究急性和晚期毒性将有望带来有价值的发现。
BACKGROUND: Soft tissue sarcomas (STS) represent a diverse group of rare malignant tumors. Currently, five to six weeks of preoperative radiotherapy (RT) combined with surgery constitute the mainstay of therapy for localized high-grade sarcomas (G2-G3). Growing evidence suggests that shortening preoperative RT courses by hypofractionation neither increases toxicity rates nor impairs oncological outcomes. Instead, shortening RT courses may improve therapy adherence, raise cost-effectiveness, and provide more treatment opportunities for a wider range of patients. Presumed higher rates of adverse effects and worse outcomes are concerns about hypofractionated RT (HFRT) for STS. This systematic
review summarizes the current evidence on preoperative HFRT for the treatment of STS and discusses toxicity and oncological outcomes compared to normofractionated RT.
METHODS: We conducted a systematic
review of clinical trials describing outcomes for preoperative HFRT in the management of STS using PubMed, the Cochrane library, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Embase, and Ovid Medline. We followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Trials on retroperitoneal sarcomas, postoperative RT, and hyperthermia were excluded. Articles published until November 30th, 2021, were included.
RESULTS: Initial search yielded 94 articles. After removal of duplicate and ineligible articles, 13 articles qualified for analysis. Eight phase II trials and five retrospective analyses were reviewed. Most trials applied 5 × 5 Gy preoperatively in patients with high-grade STS. HFRT courses did not show increased rates of adverse events compared to historical trials of normofractionated RT. Toxicity rates were mostly comparable or lower than in trials of normofractionated RT. Moreover, HFRT achieved comparable local control rates with shorter duration of therapy. Currently, more than 15 prospective studies on HFRT + / - chemotherapy are ongoing.
CONCLUSIONS: Retrospective data and phase II trials suggest preoperative HFRT to be a reasonable treatment modality for STS. Oncological outcomes and toxicity profiles were favorable. To date, our knowledge is mostly derived from phase II data. No randomized phase III trial comparing normofractionated and HFRT in STS has been published yet. Multiple ongoing phase II trials applying HFRT to investigate acute and late toxicity will hopefully bring forth valuable findings.