[Radiotherapy of skin cancers].
[Radiotherapy of skin cancers].
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DOI：
10.1016/j.canrad.2016.07.026
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发表时间：
2016-09-01
期刊：
影响因子：
--
通讯作者：
Mahe, M-A
中科院分区：
文献类型：
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作者：
Hennequin, C;Rio, E;Mahe, M-A
由于缺乏随机试验或前瞻性研究，皮肤癌的放射治疗适应症没有明确的定义。对于基底细胞癌，放射治疗通常能提供良好的局部控制，但一项随机试验表明，手术更有效，毒性更低。放射治疗的适应症是60岁以上患者的手术禁忌症，非硬皮病组织学和发生在非敏感区域。对于预后较差的鳞癌，可建议辅助性放射治疗。通常需要60到70Gy射线的剂量，并且必须根据病变的大小进行调整。辅助放射治疗似乎对促结缔组织增生性黑色素瘤有益，但对其他类型的组织学类型无效。对于局部晚期肿瘤(大量结节受累)，预防性结节照射(45-50Gy.)可降低局部失败率，但不能增加存活率。Meta分析和一项大型流行病学研究表明，默克尔细胞癌的辅助放射治疗(50-56Gy)也增加了局部控制率。如果没有手术探查(前哨淋巴结清扫)，必须包括结节区域。卡波西肉瘤对辐射敏感，可以用相对较低的剂量(24-30Gy)进行治疗。此外，皮肤淋巴瘤也是放射治疗的良好适应症：B淋巴瘤是在有限的范围内选择性治疗的。全皮肤电子治疗在T淋巴瘤中的作用仍在讨论中，但姑息性放射治疗对于皮肤结节是非常有效的。
The indications of radiotherapy for skin cancers are not clearly defined because of the lack of randomised trials or prospective studies. For basal cell carcinomas, radiotherapy frequently offers a good local control, but a randomized trial showed that surgery is more efficient and less toxic. Indications of radiotherapy are contra-indications of surgery for patients older than 60, non-sclerodermiform histology and occurring in non-sensitive areas. Adjuvant radiotherapy could be proposed to squamous cell carcinomas, in case of poor prognostic factors. Dose of 60to 70Gy are usually required, and must be modulated to the size of the lesions. Adjuvant radiotherapy seems beneficial for desmoplastic melanomas but not for the other histological types. Prophylactic nodal irradiation (45to 50Gy), for locally advanced tumours (massive nodal involvement), decreases the locoregional failure rate but do not increase survival. Adjuvant radiotherapy (50to 56Gy) for Merckel cell carcinomas increases also the local control rate, as demonstrated by meta-analysis and a large epidemiological study. Nodal areas must be included, if there is no surgical exploration (sentinel lymph node dissection). Kaposi sarcomas are radiosensitive and could be treated with relatively low doses (24to 30Gy). Also, cutaneous lymphomas are good indications for radiotherapy: B lymphomas are electively treated with limited fields. The role of total skin electron therapy for T-lymphomas is still discussed; but palliative radiotherapy is very efficient in case of cutaneous nodules.