目标:在局部晚期癌症中,出血是一种常见的临床表现,放疗(RT)提供了一种无创、耐受性良好,具有成本效益的治疗。然而,分级剂量和治疗方案的选择似乎仅仅取决于医师的偏好,而不是具体的指南.我们回顾了与给定剂量相关的姑息性止血RT的缓解率(RR)和出血持续时间的现有文献。
方法:PubMed数据库用于搜索文章,根据预定的纳入和排除标准进行评估。共54条,我们分析了截至2023年12月的过去20年发表的剂量和/或分级方案及其与RR的关系.
■各种分级方案用于姑息症状控制,包括止血.专门针对止血照射的研究和前瞻性研究很少。此外,根据我们的知识,没有正在进行的具体(前瞻性)研究.外部束放射治疗(EBRT)和近距离放射治疗均可控制出血,对于高和低生物等效剂量(BED)方案,每天或每周一次的小分割照射都是安全有效的。如果可行,根据病人的情况,一些研究支持更高的BED方案,以获得更持久的肿瘤/更高的出血反应.胸部照射的较高辐射剂量可能表明同时出现阻塞和/或吞咽困难。近距离放射治疗可以单独使用,也可以与EBRT结合使用,或者在重新照射的情况下使用。表现指数得分低的患者首选短程治疗方案。对于未来的研究,多变量分析,包括床,对于评估各种肿瘤病因的不同分割方案的疗效可能很重要。
结论:止血RT,通过EBRT和近距离放射治疗,似乎是一种安全有效的姑息治疗方法,在临床和统计学上显着减少癌症患者的出血。关于止血RT的前瞻性和统一评估,现有文献有限。包括分馏时间表。BED似乎表明特定适应症的RR更好。目前的证据表明,治疗决定应根据患者的情况进行调整,肿瘤病因和其他临床症状。为了制定明确的指南,有必要进行更多(前瞻性)的止血研究。
OBJECTIVE: In locally advanced cancer, bleeding is a common clinical presentation and radiotherapy (RT) provides a noninvasive, well-tolerated, cost-effective treatment. However, the choice for fractionation dose and schedule seem to merely depend on physician\'s preference rather than specific guidelines. We reviewed the available literature on palliative hemostatic RT for response rate (RR) and bleeding duration in relation with the given dose.
METHODS: The PubMed database was used to search for articles, which were assessed by predetermined inclusion and exclusion criteria. A total of 54 articles, published over the last 20 years until December 2023 were analyzed for dose and/or fractionation regimen and their relation to the RR.
UNASSIGNED: A variety of fractionation schedules are used for palliative symptom control, including hemostasis. Research focusing on hemostatic irradiation specifically and prospective studies are rare. Moreover, to our knowledge, there are no specific (prospective) studies ongoing. Both external beam radiotherapy (EBRT) and brachytherapy lead to bleeding control and daily or weekly hypofractionated irradiation is safe and effective for both high and low biological equivalent dose (BED) regimens. If feasible, based on patient condition, some studies favor higher BED regimens to obtain more durable tumor/higher bleeding response. Higher radiation dose for thoracic irradiation may be indicative for simultaneous presentation of obstruction and/or dysphagia. Brachytherapy may be used solely or in combination with EBRT or in the setting of re-irradiation. Short-course regimens are preferred in patients in with low performance index scores. For future studies, multivariate analysis, including BED, can be important to assess efficacy of different fractionation schedules for a variety of tumor etiologies.
CONCLUSIONS: Hemostatic RT, both by EBRT and brachytherapy, appears to be a safe and effective palliative treatment that clinically and statistically significantly reduces bleeding in cancer patients. The available literature is limited regarding prospective and uniform evaluation of hemostatic RT, including fractionation schedules. BED seems to be indicative for a better RR for specific indications. Current evidence suggests that treatment decisions should be tailored according to the patients\' condition, tumor etiology and other clinical symptoms. More (prospective) research focusing on hemostasis is necessary to develop clear guidelines.