|
|
放疗总疗程延长对恶性肿瘤的影响
|
Abstract:
放射治疗在恶性肿瘤的治疗中的地位逐年增高，目前，大约近70%的肿瘤患者需要进行放射治疗。WHO公布的官方数据显示：45%的恶性肿瘤是可以治愈的，其中外科手术治疗占22%，放疗占18%，化疗占5%。但是在放射治疗过程中，有许多会影响治疗疗效的因素，除了与肿瘤相关的临床因素，放射治疗总疗程的长短也会对放射治疗疗效产生影响，其原因可能与肿瘤细胞的亚致死性损伤修复及加速再增殖有关，从而导致恶性肿瘤治疗后的局部区域失败和远处转移的发生。我们对放疗总疗程对各类恶性肿瘤的影响的文献进行了回顾，对放疗总疗程延长影响疗效的机制，影响疗程延长的原因，预防总疗程延长的措施及发生总疗程延长后的应对措施进行了汇总。
Radiation therapy’s status in the treatment of malignant tumors has been rising steadily each year. Currently, approximately 70% of tumor patients require radiation therapy. According to official data released by WHO, 45% of malignant tumors can be cured, with surgical treatment accounting for 22%, radiation therapy for 18%, and chemotherapy for 5%. However, many factors can influence the efficacy of radiation therapy during the treatment process. In addition to tumor-related clinical factors, the duration of the total radiation therapy course can also affect its efficacy. This may be related to the repair of sublethal damage and accelerated repopulation of tumor cells, leading to local failure and distant metastasis after the treatment of malignant tumors. We have reviewed the literature on the impact of the total radiation therapy duration on various malignant tumors, summarized the mechanisms by which prolonged therapy duration affects efficacy, the reasons for therapy duration extension, preventive measures against prolonged therapy duration, and coping strategies when the total therapy duration is extended.
| [1] | 冯亚辉, 涂文玲, 余道江. 电离辐射在肿瘤放射治疗中的应用与放射生物学效应研究进展[J]. 同位素, 2023, 36(5): 538-549. |
| [2] | 张强, 吴邵雅, 张靖. 放疗对肿瘤微环境的重塑及增强免疫治疗疗效机制的研究进展[J]. 肿瘤防治研究, 2021, 48(1): 1-6. |
| [3] | 王雯珺, 郑小康, 刘佳宾. 鼻咽癌细胞株CNE1、HONE1、C666-1和CNE2的亚致死性损伤修复速度测定[J]. 南方医科大学学报, 2010, 30(4): 777-778. |
| [4] | 贺思佳, 黄倩, 程进. 高迁移率族蛋白B1与肝癌细胞再增殖及肝癌患者预后的关系[J]. 中国普通外科杂志, 2021(7): 814-821. |
| [5] | 叶伟军, 陈昆田, 何智纯. 宫颈癌肿瘤细胞再增殖与近距离放疗剂量间关系的动态监测[J]. 肿瘤研究与临床, 2001, 13(5): 303-306. |
| [6] | Yue, J., Chen, L., Cabrera, A.R., Sun, X., Zhao, S., Zheng, F., et al. (2010) Measuring Tumor Cell Proliferation with 18F-FLT PET during Radiotherapy of Esophageal Squamous Cell Carcinoma: A Pilot Clinical Study. Journal of Nuclear Medicine, 51, 528-534. https://doi.org/10.2967/jnumed.109.072124 |
| [7] | Xiang, M., Gensheimer, M.F., Pollom, E.L., Holsinger, F.C., Colevas, A.D., Le, Q., et al. (2021) Prolongation of Definitive Head and Neck Cancer Radiotherapy: Survival Impact and Predisposing Factors. Radiotherapy and Oncology, 156, 201-208. https://doi.org/10.1016/j.radonc.2020.12.025 |
| [8] | 王娅欣, 宋锐, 李志路. 全程超分割调强放疗同步化疗和尼妥珠单抗治疗中晚期鼻咽癌的疗效观察[J]. 中国肿瘤临床与康复, 2022(7): 794-797. |
| [9] | 陈明, 傅小龙, 蒋国梁. 非小细胞肺癌放疗总疗程时间对疗效的影响[J]. 癌症, 1999, 18(2): 199-202. |
| [10] | 包永兴, 惠周光. 术后放疗在接受新辅助化疗联合手术切除的非小细胞肺癌的应用进展[J]. 中华放射肿瘤学杂志, 2022(1): 90-96. |
| [11] | Bütof, R., Kirchner, K., Appold, S., L？ck, S., Rolle, A., H？ffken, G., et al. (2014) Potential Clinical Predictors of Outcome after Postoperative Radiotherapy of Non-Small Cell Lung Cancer. Strahlentherapie und Onkologie, 190, 263-269. https://doi.org/10.1007/s00066-013-0501-4 |
| [12] | Morimoto, M., Okishio, K., Akira, M., Omachi, N., Tamiya, A., Asami, K., et al. (2017) Duration of Twice-Daily Thoracic Radiotherapy and Time from the Start of Any Treatment to the End of Chest Irradiation as Significant Predictors of Outcomes in Limited-Disease Small-Cell Lung Cancer. Clinical Lung Cancer, 18, e117-e127. https://doi.org/10.1016/j.cllc.2016.09.004 |
| [13] | Bogart, J.A., Watson, D., McClay, E.F., Evans, L., Herndon, J.E., Laurie, F., et al. (2008) Interruptions of Once-Daily Thoracic Radiotherapy Do Not Correlate with Outcomes in Limited Stage Small Cell Lung Cancer: Analysis of CALGB Phase III Trial 9235. Lung Cancer, 62, 92-98. https://doi.org/10.1016/j.lungcan.2008.02.006 |
| [14] | Haviland, J.S., Bentzen, S.M., Bliss, J.M. and Yarnold, J.R. (2016) Prolongation of Overall Treatment Time as a Cause of Treatment Failure in Early Breast Cancer: An Analysis of the UK START (Standardisation of Breast Radiotherapy) Trials of Radiotherapy Fractionation. Radiotherapy and Oncology, 121, 420-423. https://doi.org/10.1016/j.radonc.2016.08.027 |
| [15] | Chow, R., Hasan, S., Choi, J.I., Fox, J., Chhabra, A.M., Marshall, D.C., et al. (2023) Effect of Treatment Interruptions on Overall Survival in Patients with Triple-Negative Breast Cancer. JNCI: Journal of the National Cancer Institute, 115, 1029-1035. https://doi.org/10.1093/jnci/djad127 |
| [16] | 刘新伟, 施学辉, 吴根娣. 后程加速超分割放射治疗食管癌的技术与结果[J]. 中华放射肿瘤学杂志, 1994(3): 150-153+216. |
| [17] | Hallemeier, C.L., Moughan, J., Haddock, M.G., Herskovic, A.M., Minsky, B.D., Suntharalingam, M., et al. (2023) Association of Radiotherapy Duration with Clinical Outcomes in Patients with Esophageal Cancer Treated in NRG Oncology Trials: A Secondary Analysis of NRG Oncology Randomized Clinical Trials. JAMA Network Open, 6, e238504. https://doi.org/10.1001/jamanetworkopen.2023.8504 |
| [18] | Mehta, S., Ramey, S.J., Kwon, D., Rich, B.J., Ahmed, A.A., Wolfson, A., et al. (2020) Impact of Radiotherapy Duration on Overall Survival in Squamous Cell Carcinoma of the Anus. Journal of Gastrointestinal Oncology, 11, 277-290. https://doi.org/10.21037/jgo.2020.02.09 |
| [19] | Harima, Y., Ariga, T., Kaneyasu, Y., Ikushima, H., Tokumaru, S., Shimamoto, S., et al. (2021) Clinical Value of Serum Biomarkers, Squamous Cell Carcinoma Antigen and Apolipoprotein C-II in Follow-Up of Patients with Locally Advanced Cervical Squamous Cell Carcinoma Treated with Radiation: A Multicenter Prospective Cohort Study. PLOS ONE, 16, e0259235. https://doi.org/10.1371/journal.pone.0259235 |
| [20] | 胡志强, 游伟程, 潘凯枫. 中、美两国癌症流行特征分析——《2023美国癌症统计报告》解读[J]. 科技导报, 2023, 41(18): 18-28. |
| [21] | Hasan, S., Gorovets, D., Lehrer, E.J., Lazarev, S., Press, R.H., Garg, M., et al. (2021) Optimal Timing of Radiotherapy in High Risk Prostate Cancer: Do Missed Days Matter? Clinical and Translational Radiation Oncology, 26, 47-54. https://doi.org/10.1016/j.ctro.2020.11.006 |
| [22] | Han, J.E., Chang, J., Rosen, L., Hartsell, W., Tsai, H., Chen, J., et al. (2020) Treatment Interruptions Affect Biochemical Failure Rates in Prostate Cancer Patients Treated with Proton Beam Therapy: Report from the Multi-Institutional Proton Collaborative Group Registry. Clinical and Translational Radiation Oncology, 25, 94-101. https://doi.org/10.1016/j.ctro.2020.10.003 |
| [23] | Baliga, S., Bajaj, B.V.M., Kabarriti, R., Grassberger, C., Patteson, B., Yeap, B., et al. (2020) Prolongation of Radiotherapy Duration Is Associated with Inferior Overall Survival in Patients with Pediatric Medulloblastoma and Central Nervous System Primitive Neuroectodermal Tumors. Pediatric Blood & Cancer, 67, e28558. https://doi.org/10.1002/pbc.28558 |
| [24] | Tsutsumi, K., Ahmed, K.H., Goshtasbi, K., Torabi, S.J., Mohyeldin, A., Hsu, F.P.K., et al. (2022) Impact of Esthesioneuroblastoma Treatment Delays on Overall Patient Survival. The Laryngoscope, 133, 764-772. https://doi.org/10.1002/lary.30136 |
| [25] | Pepin, A.N., Zwart, A., Danner, M., Ayoob, M., Yung, T., Collins, B.T., et al. (2022) Treatment Interruptions during Stereotactic Body Radiotherapy for Prostate Cancer. Frontiers in Oncology, 11, Article ID: 796496. https://doi.org/10.3389/fonc.2021.796496 |
| [26] | Li, C., Xie, J., Wang, J., Cao, Y., Pu, M., Gong, Q., et al. (2022) Therapeutic Effects and Mechanisms of Plant-Derived Natural Compounds against Intestinal Mucositis. Frontiers in Pharmacology, 13, Article ID: 969550. https://doi.org/10.3389/fphar.2022.969550 |
| [27] | Rao, D., Behzadi, F., Le, R.T., Dagan, R. and Fiester, P. (2021) Radiation Induced Mucositis: What the Radiologist Needs to Know. Current Problems in Diagnostic Radiology, 50, 899-904. https://doi.org/10.1067/j.cpradiol.2020.10.006 |
| [28] | Alexidis, P., Kolias, P., Mentesidou, V., Topalidou, M., Kamperis, E., Giannouzakos, V., et al. (2023) Investigating Predictive Factors of Dysphagia and Treatment Prolongation in Patients with Oral Cavity or Oropharyngeal Cancer Receiving Radiation Therapy Concurrently with Chemotherapy. Current Oncology, 30, 5168-5178. https://doi.org/10.3390/curroncol30050391 |
| [29] | Ma, Z., Liang, B., Wei, R., Liu, Y., Bao, Y., Yuan, M., et al. (2023) Enhanced Prediction of Postoperative Radiotherapy‐Induced Esophagitis in Non‐Small Cell Lung Cancer: Dosiomic Model Development in a Real‐World Cohort and Validation in the Port‐C Randomized Controlled Trial. Thoracic Cancer, 14, 2839-2845. https://doi.org/10.1111/1759-7714.15068 |
| [30] | 徐菁, 巩圆圆, 谭靖. 宫颈癌放射性直肠炎对症支持治疗的研究进展[J]. 癌症进展, 2021, 19(6): 560-562. |
| [31] | 吴才贤, 高献明, 黄晓捷. 急性放射性直肠炎的治疗进展[J]. 江苏医药, 2023, 49(1): 94-97. |
| [32] | Yang, X., Ren, H., Guo, X., Hu, C. and Fu, J. (2020) Radiation-Induced Skin Injury: Pathogenesis, Treatment, and Management. Aging, 12, 23379-23393. https://doi.org/10.18632/aging.103932 |
| [33] | 范铭, 冯梅, 袁双虎. 放射性皮炎的预防与治疗临床实践指南[J]. 中华肿瘤防治杂志, 2023, 30(6): 315-323. |
| [34] | Zhao, J., Zheng, H., Li, L., Zhang, L., Zhao, Y. and Jiang, N. (2015) Predictors for Weight Loss in Head and Neck Cancer Patients Undergoing Radiotherapy: A Systematic Review. Cancer Nursing, 38, E37-E45. https://doi.org/10.1097/ncc.0000000000000231 |
| [35] | Bansal, A., Kapoor, R., Kumar, S. and Miriyala, R. (2016) Factors Influencing Compliance to Radical Treatment of Middle Thoracic Esophageal Cancer: An Audit from a Regional Cancer Centre. Indian Journal of Palliative Care, 22, 288. https://doi.org/10.4103/0973-1075.185037 |
| [36] | 张晓凤, 张一曼, 张红杰. 癌症患者服用口服营养补充剂的效果[J]. 医学研究与教育, 2021, 38(5): 36-44. |
| [37] | Zheng, Z., Zhao, X., Zhao, Q., Zhang, Y., Liu, S., Liu, Z., et al. (2021) The Effects of Early Nutritional Intervention on Oral Mucositis and Nutritional Status of Patients with Head and Neck Cancer Treated with Radiotherapy. Frontiers in Oncology, 10, Article ID: 595632. https://doi.org/10.3389/fonc.2020.595632 |
| [38] | Chen, A.M., Hsu, S., Felix, C., Garst, J. and Yoshizaki, T. (2017) Effect of Psychosocial Distress on Outcome for Head and Neck Cancer Patients Undergoing Radiation. The Laryngoscope, 128, 641-645. https://doi.org/10.1002/lary.26751 |
| [39] | Pecha？ová, Z. and Lohynská, R. (2021) Clinical Application of Time Factor Principles in Radiotherapy in Compensation of Radiation Series Interruptions. Klinicka Onkologie, 34, 455-462. https://doi.org/10.48095/ccko2021455 |
