Hypofractionated ablative radiotherapy for locally advanced pancreatic cancer.
Hypofractionated ablative radiotherapy for locally advanced pancreatic cancer.
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DOI：
10.1093/jrr/rrw016
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发表时间：
2016-08
影响因子：
2
通讯作者：
Crane CH
中科院分区：
文献类型：
--
作者：
Crane CH
放射治疗在局部晚期不能切除的胰腺癌(LAPC)中的作用存在争议。评估标准剂量放化疗的随机试验并未显示使用巩固放射治疗有显著益处。3-5次立体定向全身放射治疗(SBRT)的非随机研究结果与标准化疗相似，但毒性更小，治疗时间更短。出于耐受性考虑，SBRT的剂量已降至亚消融水平。这两种选择的好处尚不清楚。相比之下，消融剂量可以使用SBRT技术在15-28个分数内提供。提供消融剂量的关键是计算机断层扫描(CT)图像引导和呼吸门控。更高的剂量导致了令人鼓舞的长期生存结果。在这篇综述中，我们提出了一种综合的解决方案，通过结合经典的、现代的和新的放射治疗概念：分割、CT图像引导、呼吸门控、有意剂量异质性和同时综合保护，为选定的胰腺肿瘤患者实现消融剂量。
The role of radiation in locally advanced unresectable pancreatic cancer (LAPC) is controversial. Randomized trials evaluating standard doses of chemoradiation have not shown a significant benefit from the use of consolidative radiation. Results from non-randomized studies of 3–5-fraction stereotactic body radiotherapy (SBRT) have been similar to standard chemoradiation, but with less toxicity and a shorter treatment time. Doses of SBRT have been reduced to subablative levels for the sake of tolerability. The benefit of both options is unclear. In contrast, ablative doses can be delivered using an SBRT technique in 15–28 fractions. The keys to the delivery of ablative doses are computed tomography (CT) image guidance and respiratory gating. Higher doses have resulted in encouraging long-term survival results. In this review, we present a comprehensive solution to achieving ablative doses for selected patients with pancreatic tumors by using a combination of classical, modern and novel concepts of radiotherapy: fractionation, CT image guidance, respiratory gating, intentional dose heterogeneity, and simultaneous integrated protection.