Evidence-based clinical recommendations for hypofractionated radiotherapy: exploring efficacy and safety - Part 4: Liver and locally recurrent rectal cancer.

Radiation oncology journal Pub Date : 2024-12-01 Epub Date: 2024-12-19 DOI:10.3857/roj.2024.00108
Hwa Kyung Byun, Gyu Sang Yoo, Soo-Yoon Sung, Jin-Ho Song, Byoung Hyuck Kim, Yoo-Kang Kwak, Yeon Joo Kim, Yeon-Sil Kim, Kyung Su Kim
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Abstract

In this paper, we review the use of hypofractionated radiotherapy for gastrointestinal malignancies, focusing on primary and metastatic liver cancer, and recurrent rectal cancer. Technological advancements in radiotherapy have facilitated the direct delivery of high-dose radiation to tumors, while limiting normal tissue exposure, supporting the use of hypofractionation. Hypofractionated radiotherapy is particularly effective for primary and metastatic liver cancer where high-dose irradiation is crucial to achieve effective local control. For recurrent rectal cancer, the use of stereotactic body radiotherapy offers a promising approach for re-irradiation, balancing efficacy and safety in patients who have been administered previous pelvic radiotherapy and in whom salvage surgery is not applicable. Nevertheless, the potential for radiation-induced liver disease and gastrointestinal complications presents challenges when applying hypofractionation to gastrointestinal organs. Given the lack of universal consensus on hypofractionation regimens and the dose constraints for primary and metastatic liver cancer, as well as for recurrent rectal cancer, this review aims to facilitate clinical decision-making by pointing to potential regimens and dose constraints, underpinned by a comprehensive review of existing clinical studies and guidelines.

低分割放疗的循证临床建议:探索有效性和安全性-第4部分:肝癌和局部复发性直肠癌。
在本文中,我们回顾了低分割放疗在胃肠道恶性肿瘤中的应用,重点是原发性和转移性肝癌,以及复发性直肠癌。放射治疗的技术进步促进了高剂量辐射对肿瘤的直接输送,同时限制了正常组织的暴露,支持了低分割的使用。低分割放疗对原发性和转移性肝癌特别有效,其中高剂量放疗对于实现有效的局部控制至关重要。对于复发性直肠癌,使用立体定向放射治疗对于先前接受过盆腔放射治疗且不能进行挽救性手术的患者来说,提供了一种很有前途的再照射方法,可以平衡疗效和安全性。然而,当对胃肠道器官进行低分割时,潜在的辐射引起的肝脏疾病和胃肠道并发症提出了挑战。鉴于对原发性和转移性肝癌以及复发性直肠癌的低分割方案和剂量限制缺乏普遍共识,本综述旨在通过对现有临床研究和指南的全面回顾,指出潜在的方案和剂量限制,从而促进临床决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
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