目的:血液恶性肿瘤的特殊性在于它们通常可以治愈,即使诊断时存在远处转移,不像实体恶性肿瘤.系统性治疗,包括化疗,靶向治疗,和免疫疗法,是护理的标准与优异的结果。在过去的20年中,这些疾病的管理取得了长足的进步,重新定义了放射治疗在许多临床情况下的作用。我们提出了对数据的文献综述,表明放射治疗仍然有治愈作用,打捞,和姑息治疗情况。
方法:在以下数据库中进行了文档和文献检索:Medline和ClinicalTrial.gov,术语“放射治疗”,“血液恶性肿瘤”,“霍奇金淋巴瘤”,“非霍奇金淋巴瘤”,“CART细胞”,“多发性骨髓瘤”,“孤立性浆细胞瘤”,“调强放疗”,“颅外立体定向身体放射治疗”和“质子治疗参考”。
结果:血液病理学恶性肿瘤包括多种疾病,在过去的20年中已经评估了放射治疗的适应症。目前,放射治疗适用于局部疾病(孤立性浆细胞瘤),作为佐剂(霍奇金淋巴瘤),在姑息环境中,或在复发患者(嵌合抗原受体[CAR]T细胞)的全身治疗后,复发负担低,因此,这可以被认为是“寡复发”。放射治疗,通过全身照射,有重要的适应症,由于其免疫调节和/或清髓作用。此外,最近的技术发展使得安全性有可能显著提高,有助于放射治疗被定位在几个适应症的治疗策略中。
结论:鉴于系统治疗血液系统恶性肿瘤的有效性,寡转移阶段的重要性不大。局部放射治疗后的治愈意图,即使是高级阶段,是可能的,都患有晚期霍奇金淋巴瘤的残留病,侵袭性非霍奇金淋巴瘤,或者孤立性浆细胞瘤,甚至在霍奇金或非霍奇金淋巴瘤化疗后没有疾病的证据。新疗法的作用,例如CAR-T细胞,允许我们在全身治疗低体积复发的复发性疾病后考虑放射治疗,这可以被认为是少复发。
OBJECTIVE: Haematologic malignancies are particular in that they can generally be cured, even when distant metastases are present at diagnosis, unlike solid malignancies. Systemic treatments, including chemotherapy, targeted therapies, and immunotherapy, are the standard of care with excellent results. The considerable progress made in the management of these diseases in the last 20years has redefined the role of radiation therapy as minor in many clinical situations. We propose a literature review of data, showing that radiation therapy still has a role in curative, salvage, and palliative therapy situations.
METHODS: A document and literature search was carried out in the following databases: Medline and ClinicalTrial.gov, for the terms \"radiotherapy\", \"haematologic malignancies\", \"Hodgkin lymphoma\", \"non-Hodgkin lymphoma\", \"CAR T cells\", \"multiple myeloma\", \"solitary plasmocytoma\", \"intensity-modulated radiotherapy\", \"extracranial stereotactic body radiation therapy\" and \"proton therapy references\".
RESULTS: Haemopathological malignancies include a wide range of diseases and radiation therapy indications have been assessed over the past 20years. Currently, radiation therapy is indicated for localized disease (solitary plasmocytoma), as an adjuvant (Hodgkin lymphoma), in palliative settings, or after systemic treatment in relapsed patients (chimeric antigen receptor [CAR] T-cells) with a low recurrence burden, which can therefore be considered \"oligorecurrence\". Radiation therapy, through total body irradiation, has important indications, thanks to its immunomodulatory and/or myeloablative effects. Moreover, recent technological developments have made possible significant improvement in safety, contributing to radiation therapy being positioned in the treatment strategy of several indications.
CONCLUSIONS: Given the effectiveness of systemic treatments in hematologic malignancies, the oligometastasis stage is of little importance. A curative intent after local radiation therapy, even advanced stage, is possible, both with residual disease for advanced Hodgkin lymphoma, aggressive non-Hodgkin lymphoma, or solitary plasmocytoma, and even without evidence of disease after chemotherapy for Hodgkin or non-Hodgkin lymphoma. The role of new treatments, such as CAR T cells, allows us to consider radiation therapy after systemic treatment of relapsed diseases with low volume recurrence, which can be considered oligorecurrence.