Novel stereotactic body radiation therapy (SBRT)-based partial tumor irradiation targeting hypoxic segment of bulky tumors (SBRT-PATHY): improvement of the radiotherapy outcome by exploiting the bystander and abscopal effects
Novel stereotactic body radiation therapy (SBRT)-based partial tumor irradiation targeting hypoxic segment of bulky tumors (SBRT-PATHY): improvement of the radiotherapy outcome by exploiting the bystander and abscopal effects
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DOI：
10.1186/s13014-019-1227-y
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发表时间：
2019-01-29
影响因子：
3.6
通讯作者：
Brcic, Luka
中科院分区：
文献类型：
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作者：
Tubin, Slavisa;Popper, Helmut H.;Brcic, Luka
背景尽管肿瘤学取得了进步，但巨大肿瘤患者的预后较差，通常只能接受姑息治疗。巨大的疾病是一个重要的挑战性障碍，所有目前可用的根治性治疗方案，包括传统的放射治疗。本研究的目的是评估一种新开发的非传统立体定向体部放射治疗（SBRT）用于不能切除的巨大肿瘤（仅针对其下丘脑节段）的垂体肿瘤照射的回顾性结局（SBRT-PATHY），利用放射治疗的非靶向效应：旁观者效应（局部）和远位效应（远端）。3例大体积肿瘤患者接受局部大体积照射，以诱导局部非靶向辐射效应（旁观者效应）。乏氧肿瘤节段，称为旁观者肿瘤体积（BTV），使用PET和对比增强CT定义为中央坏死和外周高血管化高代谢肿瘤节段之间的低血管化低代谢交界区。根据肿瘤的部位和体积，BTV用1-3次10- 12 Gy的剂量照射至70%等剂量线。未对病理性淋巴结和转移灶进行辐照，以评估放射的远端非靶向效应（远端效应）。没有患者接受任何系统therapy.ResultsAt分析时，中位随访时间为9.4个月（范围：4-20），87%的患者保持无进展。旁观者和远位反应率分别为96%和52%。部分照射的大体积肿瘤表达旁观者效应强度的中位收缩率为70%（范围30-100%），而对于未照射的转移灶（远位效应强度），为50%（范围30-100%）。没有病人经历过任何等级的急性或晚期毒性。ConclusionsSBRT-PATHY显示非常鼓舞人心的结果开发的辐射缺氧诱导的非靶向效应，需要通过我们正在进行的前瞻性trial.Present研究证实已被当地伦理委员会的研究编号A 26/18下的回顾性注册。
BackgroundDespite the advances in oncology, patients with bulky tumors have worse prognosis and often receive only palliative treatments. Bulky disease represents an important challenging obstacle for all currently available radical treatment options including conventional radiotherapy. The purpose of this study was to assess a retrospective outcome on the use of a newly developed unconventional stereotactic body radiation therapy (SBRT) for PArtial Tumor irradiation of unresectable bulky tumors targeting exclusively their HYpoxic segment (SBRT-PATHY) that exploits the non-targeted effects of radiotherapy: bystander effects (local) and the abscopal effects (distant).Materials and methodsTwenty-three patients with bulky tumors received partial bulky irradiation in order to induce the local non-targeted effect of radiation (bystander effect). The hypoxic tumor segment, called the bystander tumor volume (BTV), was defined using PET and contrast-enhanced CT, as a hypovascularized-hypometabolic junctional zone between the central necrotic and peripheral hypervascularized-hypermetabolic tumor segment. Based on tumor site and volume, the BTV was irradiated with 1-3 fractions of 10-12Gy prescribed to 70% isodose-line. The pathologic lymph nodes and metastases were not irradiated in order to assess the distant non-targeted effects of radiation (abscopal effect). No patient received any systemic therapy.ResultsAt the time of analysis, with median follow-up of 9.4months (range: 4-20), 87% of patients remained progression-free. The bystander and abscopal response rates were 96 and 52%, respectively. Median shrinkage of partially irradiated bulky tumor expressing intensity of the bystander effect was 70% (range 30-100%), whereas for the non-irradiated metastases (intensity of the abscopal effect), it was 50% (range 30-100%). No patient experienced acute or late toxicity of any grade.ConclusionsSBRT-PATHY showed very inspiring results on exploitation of the radiation-hypoxia-induced non-targeted effects that need to be confirmed through our ongoing prospective trial.Present study has been retrospectively registered by the local ethic committee under study number A 26/18.