超低分割放疗治疗非黑色素瘤皮肤癌：系统回顾和荟萃分析

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-01 DOI:10.1016/S0167-8140(25)04735-8

Jaehyeong Yang , Grace Xiong , Shaheer Shahhat , Andrew Arifin , Adam Mutsaers

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引用次数: 0

摘要

目的：根治性超低分割放疗（UHRT）治疗非黑色素瘤皮肤癌（NMSC）越来越多地用于缩短治疗时间。关于不同治疗方案的有效性和安全性的前瞻性数据有限，特别是与更分散的治疗方案相比。进行了系统回顾和汇总分析，以综合现有的最佳证据。材料和方法：检索Cochrane， Medline和Embase数据库，从建立到2024年7月，以评估接受UHRT治疗的NMSC患者的研究。纳入了每组分剂量大于5 Gy和生物等效剂量（BED10）大于45 Gy的分离计划的研究。排除了非定量主要终点、未单独报告分级的混合队列和其他确定治疗（近距离治疗、常规放疗、手术）。检查12个月和24个月局部控制（LC）、有效率、总生存期（OS）、美容和毒性的结果，并计算加权平均值和置信区间。结果：17项研究（6087个病变，4192例患者）符合纳入标准，其中15项研究符合共同终点的定量分析。14项研究为回顾性研究，3项为前瞻性研究。研究规模各不相同，中位数为38例患者（范围：12-1149）和112例病变（范围：15-1715）。辐射按1-12个部分进行，每部分的剂量为5-30 Gy。不同研究的辐射计划和技术存在差异。3项研究报告的1年LC （LC1）为89.6% (n= 3,325个病灶，95%CI: 77.7-101.5%)， LC2为95.5% （n=6，没有与LC1重叠的研究证明更高的LC， 2098个病灶，95%CI: 80.9 -102.0%）。在8项涉及432个病变的研究中，完全缓解率为78.6%，部分缓解率为12.0%。1年OS （OS1）为58.4% (n= 4170例，95%CI: 46.0 ~ 70.7%)， OS2为46.0% （n= 4184例，95%CI: 21.0 ~ 70.9%）。在11项报告毒性的研究中，治疗耐受性良好，其中一项研究报告急性4级毒性发生率为2.5% （n=6）。6项研究报告了2097个病变的美容，78.2%的患者报告了良好的评分。结论：在一个异质性的NMSC放射治疗队列中，超低分割提供了良好的LC，适度的毒性和可接受的美容。进一步的前瞻性评价是必要的。

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ULTRA-HYPOFRACTIONATED RADIOTHERAPY FOR NON-MELANOMA SKIN CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

Purpose:

Radical intent ultra-hypofractionated radiotherapy (UHRT) to treat non-melanoma skin cancer (NMSC) is increasingly used to decrease treatment time. Limited prospective data exists on the efficacy and safety of different regimens, particularly in comparison to more fractionated regimens. A systematic review and pooled analysis was done to synthesize best available evidence.

Materials and Methods:

Cochrane, Medline and Embase databases were queried from inception to July 2024 for studies evaluating patients with NMSC treated with UHRT. Studies with fractionation schedules of doses-per-fraction greater than 5 Gy and biologically equivalent dose (BED10) greater than 45 Gy were included. Nonquantitative primary endpoints, mixed cohorts failing to report fractionation separately, and other definitive treatments (brachytherapy, conventional radiotherapy, surgery) were excluded. Results for 12- and 24-month local control (LC), response rate, overall survival (OS), cosmesis and toxicity were examined, and weighted-mean and confidence intervals were calculated.

Results:

Seventeen studies met inclusion criteria (6087 lesions, 4192 patients), with fifteen studies eligible for quantitative analysis of common endpoints. Fourteen studies were retrospective and three were prospective. Study size varied, with a median of 38 patients (range:12-1149) and 112 lesions (range:15-1715). Radiation was delivered in 1-12 fractions with doses-per-fraction of 5-30 Gy. Radiation schedule and technique were heterogeneous across studies. One-year LC (LC1) reported in three studies was 89.6% (n=3, 325 lesions, 95%CI: 77.7-101.5%) and LC2 was 95.5% (n=6, no overlapping studies with LC1 justifying higher LC, 2098 lesions, 95%CI: 89.0-102.0%). In 8 studies with 432 lesions, complete response was 78.6% and partial response was 12.0%. One-year OS (OS1) was 58.4% (n=4, 170 patients, 95%CI: 46.0-70.7%) and OS2 was 46.0% (n=4, 184 patients, 95%CI: 21.0-70.9%). In 11 studies reporting toxicity, treatment was well tolerated with a single study reporting 2.5% (n=6) incidence of acute Grade 4 toxicity. Cosmesis was reported in 6 studies with 2097 lesions, with 78.2% reporting fair to excellent grades.

Conclusions:

In a heterogeneous cohort of radiation treatments for NMSC, ultra-hypofractionation offers excellent LC, modest toxicity and acceptable cosmesis. Further prospective evaluation is warranted.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.