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针对局部晚期宫癌的放射治疗的精细化:一个历史的视角
María Caicedo-Martínez1, Andrés F Arbeláez-Mariño2, Lina Arbeláez3
1Department of Radiation Oncology, Centro de Control de Cancer, Bogotá, Colombia.
概括
对于局部晚期子宫癌的放射治疗的进步优化了治疗,但尚未降低护理. 改善对现代技术的获取和进行试验对于未来的降级战略至关重要.
科学领域:
- 在瘤学瘤学.
- 辐射瘤学 辐射瘤学
- 妇科瘤学 妇科瘤学
背景情况:
- 当地发达的宫癌在全球的健康状况上存在显著的差异.
- 自1999年以来,并发化疗是治疗的标准.
- 放射治疗已经进化,但真正的缓和是不确定的.
研究的目的:
- 审查关于本地晚期宫癌的确定的放射治疗的历史和当前证据.
- 探索潜在治疗降级的策略.
- 评估技术进步是否意味着真正的降级.
主要方法:
- 标志性试验和当代证据的叙述性审查.
- 专注于精制的外部光束放射疗法 (EBRT) 和臂治疗技术.
- 系统治疗和整体治疗时间优化的分析.
主要成果:
- 技术进步 (3D-CRT,IMRT/VMAT,IGABT) 降低了毒性,同时保持/改善了控制.
- 在EMBRACE试验中,使用MRI引导的自适应式支臂疗法,显示出高局部控制率与降低的发病率.
- 精确降级包括选择性扩展场辐射和节点增强.
结论:
- 目前的放射治疗进展是优化,而不是最终的缓解.
- 真正的降级需要更好地获得先进的EBRT和支臂疗法.
- 未来的降级需要严格的试验和生物指导的患者选择.
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