立体定向放疗的非靶向效应:来自临床领域的证据综述。

Q3 Medicine
Exploration of targeted anti-tumor therapy Pub Date : 2025-02-13 eCollection Date: 2025-01-01 DOI:10.37349/etat.2025.1002290
Angela Barillaro, Mara Caroprese, Chiara Feoli, Emanuele Chioccola, Christina Amanda Goodyear, Caterina Oliviero, Stefania Clemente, Antonio Farella, Manuel Conson, Roberto Pacelli
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引用次数: 0

摘要

背景:临床前动物研究表明,放射治疗(RT)可以诱导辐射解剖部位以外的影响。RT (NTER)的非靶向效应在临床中偶有报道。然而,随着高剂量立体定向放射技术(SRT)和免疫疗法(IT)的出现,人们重新关注NTER。本系统综述旨在总结目前关于各种恶性肿瘤中NTER的知识,重点是涉及SRT的病例。方法:进行系统的数据库检索,并按照PRISMA指南筛选记录。我们只收录了用英文撰写的报告SRT后涉及NTER临床研究的全文原创文章。结果按癌症类型分类,有单独的一般和关键分析。结果:共回顾了63项研究,包括32例病例报告/病例系列、18项回顾性研究和13项前瞻性研究,主要发表于2018年以后。NTER最常在黑色素瘤和肺癌中观察到,通常报道为体外效应(AE),尽管标准不同。在大多数病例中,在SRT时,反应不佳的IT正在进行,到NTER发作的中位时间为3个月。总的来说,297例患者记录了NTER: 34例来自单个病例,263例来自其他研究的1212例可评估患者(22%)。前瞻性试验报告NTER率为36%,在肺癌中上升至56%。讨论:在前瞻性临床研究中,在相当比例的患者中观察到SRT后的NTER现象。然而,文献是有限的,患者队列小。人们对NTER的兴趣越来越大,尤其是在IT领域。定义和报告的标准化,以及开展更多的临床试验,对于更好地了解SRT如何诱发NTER至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Non-targeted effects of stereotactic radiotherapy: a review of the evidence coming from the clinical field.

Background: Preclinical animal studies have demonstrated that radiation treatment (RT) can induce effects beyond the anatomical site of irradiation. Non-targeted effects of RT (NTER) have been sporadically reported in clinical settings. However, with the advent of high-dose stereotactic radiation techniques (SRT) and immunotherapy (IT), renewed attention has been given to NTER. This systematic review aims to summarize current knowledge about NTER across various malignancies, with a focus on cases involving SRT.

Methods: A systematic database search was performed, and records were screened following PRISMA guidelines. Only full-text original articles written in English and reporting clinical studies involving NTER after SRT were included. The results are categorized by cancer type, with separate general and critical analyses.

Results: Sixty-three studies were reviewed, including 32 case reports/case series, 18 retrospective studies, and 13 prospective studies, predominantly published after 2018. NTER was most frequently observed in melanoma and lung cancer and commonly reported as the abscopal effect (AE), albeit with varying criteria. In most cases, IT with suboptimal response was ongoing at the time of SRT, and the median time to NTER onset was 3 months. Overall, NTER was documented in 297 patients: 34 from single cases and 263 from a pool of 1,212 evaluable patients (22%) across other studies. Prospective trials reported an NTER rate of 36%, rising to 56% in lung cancer.

Discussion: In prospective clinical studies, the phenomenon of NTER following SRT has been observed in a significant proportion of patients. Nevertheless, the literature is limited, with small patient cohorts. Interest in NTER has grown, particularly in the context of IT. Standardization of definitions and reporting, along with the conduct of more clinical trials, is essential to better understand how NTER can be induced by SRT.

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CiteScore
2.80
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