tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2020-10-3-5-14tumors-817Research ArticleОБЗОРЫ И АНАЛИТИКАREVIEWS AND ANALYSISЛучевая терапия при олигометастатическом ракеRadiation therapy for oligometastatic cancerДеньгинаН. В.DenginaN.  V.

Наталья В. Деньгина, к. м. н., заведующая радиологическим отделением, ГУЗ «Областной клинический онкологический диспансер», директор по лечебным вопросам Центра Томотерапии «R-Spei»

Ульяновск

Natalia V. Dengina, MD, PhD, Head of Radiotherapy Department, Ulyanovsk Regional Clinical Cancer Center, director of TomoTherapy Center «R-Spei»

Ulyanovsk

indigo.radonc@gmail.comМитинТ. В.MitinT. V.

Тимур В. Митин, д. м. н., отделение радиационной медицины 

Портленд

Timur V. Mitin, MD, PhD, Radiation Medicine

Portland

ТимофеевИ. В.TsimafeyeuI.  V.

Илья В. Тимофеев, онколог, директор

Москва

Ilya V. Tsimafeyeu, Oncologist, Director

Moscow

УсычкинС. В.UsychkinS.  V.

Сергей В. Усычкин, к. м. н., заведующий отделением лучевой терапии, Институт онкологии «Хадасса Москва», заведующий отделением лучевой терапии, Медицинский центр «Медскан»

Москва

Sergey V. Usychkin, MD, PhD, Head of Radiotherapy Department, Institute of Oncology, Hadassah Medical Moscow, Head of Radiotherapy Department of Medical Center «Medscan»

Moscow

ГУЗ «Областной клинический онкологический диспансер»РоссияUlyanovsk Regional Clinical Cancer CenterRussian FederationУниверситет Здоровья и Науки ОрегонаСоединённые Штаты АмерикиOregon Health and Science UniversityUnited StatesИнститут онкологии «Хадасса Москва»РоссияInstitute of Oncology Hadassah MedicalRussian FederationИнститут онкологии «Хадасса Москва»; Медицинский центр «Медскан»РоссияInstitute of Oncology Hadassah Medical; Medical Center «Medscan»Russian Federation202028052021103514Copyright © Деньгина Н.В., Митин Т.В., Тимофеев И.В., Усычкин С.В., 20212021Деньгина Н.В., Митин Т.В., Тимофеев И.В., Усычкин С.В.Dengina N.V., Mitin T.V., Tsimafeyeu I.V., Usychkin S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/817

Современные подходы к лечению больных с метастатическими злокачественными опухолями значительно изменились за последнее десятилетие. Вместо сугубо паллиативной системной или только поддерживающей терапии немалой части больных проводится и активное локальное воздействие не только на первичную опухоль, но и на метастатические очаги, и ряд исследований демонстрирует преимущество такого подхода. В этом обзоре представлена информация о роли лучевой терапии как локального метода в лечении онкологических больных с олигометастазами.

Current approaches to the treatment of patients with metastatic malignant tumors have changed significantly over the past decade. Instead of a purely palliative systemic or just supportive therapy, a large proportion of patients receive an aggressive local treatment directed not only to the primary tumor, but also to metastatic foci, and a number of studies demonstrate the advantage of such approach. This review provides information on the role of radiation therapy as a local method of treatment of cancer patients with oligometastases.

олигометастазылучевая терапияSBRTабскопальный эффектиммунотерапияoligometastasesradiation therapySBRTabscopal effectimmunotherapyReferencesHellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13 (1):8–10.Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13 (1):8–10.Lievens I, Guckenberger M, Gomez D, et al. ESTRO-ASTRO OMD Consensus Document. Radiotherapy and Oncology 2020;148:157–166Lievens I, Guckenberger M, Gomez D, et al. ESTRO-ASTRO OMD Consensus Document. Radiotherapy and Oncology 2020;148:157–166Guckenberger M, Lievens Y, Bouma AB, et al. Characterization and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organization for Research and Treatment of Cancer consensus recommendation. The Lancet Oncology. 2020;21 (1):e18–28Guckenberger M, Lievens Y, Bouma AB, et al. Characterization and classification of oligometastatic disease: a European Society for Radiotherapy and Oncology and European Organization for Research and Treatment of Cancer consensus recommendation. The Lancet Oncology. 2020;21 (1):e18–28Greco C, Pares O, Pimentel N, et al. Phenotype-Oriented Ablation of Oligometastatic Cancer with Single Dose Radiation Therapy. IJROBP 2019;104 (3):593–603Greco C, Pares O, Pimentel N, et al. Phenotype-Oriented Ablation of Oligometastatic Cancer with Single Dose Radiation Therapy. IJROBP 2019;104 (3):593–603Arnold KM, Flynn NJ, Raben A, et al. The Impact of Radiation on the Tumor Microenvironment: Effect of Dose and Fractionation Schedules. Cancer Growth and Metastasis 2018;11:1–17Arnold KM, Flynn NJ, Raben A, et al. The Impact of Radiation on the Tumor Microenvironment: Effect of Dose and Fractionation Schedules. Cancer Growth and Metastasis 2018;11:1–17Tree AC, Khoo VS, Eeles RA, et al. Stereotactic body radiotherapy for oligometastases. Lancet Oncol 2013;14 (1):e28–37Tree AC, Khoo VS, Eeles RA, et al. Stereotactic body radiotherapy for oligometastases. Lancet Oncol 2013;14 (1):e28–37Gomez DR, Blumenschein GR Jr, Lee JJ, et al: Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: A multicentre, randomised, controlled, phase 2 study. Lancet Oncol 2016;17:1672–1682Gomez DR, Blumenschein GR Jr, Lee JJ, et al: Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: A multicentre, randomised, controlled, phase 2 study. Lancet Oncol 2016;17:1672–1682Gomez DR, Tang C, Zhang J, et al. Local Consolidative Therapy Vs. Maintenance Therapy or Observation for Patients With Oligometastatic Non — Small-Cell Lung Cancer: Long-Term Results of a Multi-Institutional, Phase II, Randomized Study. J Clin Oncol 2019;37:1558–1565Gomez DR, Tang C, Zhang J, et al. Local Consolidative Therapy Vs. Maintenance Therapy or Observation for Patients With Oligometastatic Non — Small-Cell Lung Cancer: Long-Term Results of a Multi-Institutional, Phase II, Randomized Study. J Clin Oncol 2019;37:1558–1565Iyengar P, Wardak Z, Gerber DE, et al: Consolidative radiotherapy for limited metastatic non-small-cell lung cancer: A phase 2 randomized clinical trial. JAMA Oncol 2018;4: e173501Iyengar P, Wardak Z, Gerber DE, et al: Consolidative radiotherapy for limited metastatic non-small-cell lung cancer: A phase 2 randomized clinical trial. JAMA Oncol 2018;4: e173501Palma DA, Olson R, Harrow S, et al. Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial. J Clin Oncol 2020;38Palma DA, Olson R, Harrow S, et al. Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers: Long-Term Results of the SABR-COMET Phase II Randomized Trial. J Clin Oncol 2020;38Petrelli F, Ghidini A, Cabiddu M, et al., Addition of radiotherapy to the primary tumour in oligometastatic NSCLC: A systematic review and meta-analysis. Lung Cancer 2018;126:194–200Petrelli F, Ghidini A, Cabiddu M, et al., Addition of radiotherapy to the primary tumour in oligometastatic NSCLC: A systematic review and meta-analysis. Lung Cancer 2018;126:194–200Abuodeh Y, Venkat P, Kim S. Systematic review of case reports on the abscopal effect Curr Probl Cancer 2016;40:25–37Abuodeh Y, Venkat P, Kim S. Systematic review of case reports on the abscopal effect Curr Probl Cancer 2016;40:25–37Demaria S, Ng B, Devitt ML, Babb JS, Kawashima N, Liebes L, et al. Ionizing radiation inhibition of distant untreated tumors (abscopal effect) is immune mediated. Int J Radiat Oncol Biol Phys. 2004;58:862–70.Demaria S, Ng B, Devitt ML, Babb JS, Kawashima N, Liebes L, et al. Ionizing radiation inhibition of distant untreated tumors (abscopal effect) is immune mediated. Int J Radiat Oncol Biol Phys. 2004;58:862–70.Friedman D, Baird JR, Young KH et al. Programmed cell death-1 blockade enhances response to stereotactic radiation in an orthotopic murine model of hepatocellular carcinoma. Hepatology Research 2016;47 (7): 702–714Friedman D, Baird JR, Young KH et al. Programmed cell death-1 blockade enhances response to stereotactic radiation in an orthotopic murine model of hepatocellular carcinoma. Hepatology Research 2016;47 (7): 702–714Postow MA, Callahan MK, Barker CA, et al. Immunologic Correlates of the Abscopal Effect in a Patient with Melanoma. N Engl J Med 2012;366:925–931Postow MA, Callahan MK, Barker CA, et al. Immunologic Correlates of the Abscopal Effect in a Patient with Melanoma. N Engl J Med 2012;366:925–931Chicas-Sett R, Morales-Orue I, Castilla-Martinez J, et al. Combining radiotherapy and ipilimumab induces clinically relevant radiation-induced abscopal effects in metastatic melanoma patients: A systematic review. Clinical and Translational Radiation Oncology 2018;9: P5–11Chicas-Sett R, Morales-Orue I, Castilla-Martinez J, et al. Combining radiotherapy and ipilimumab induces clinically relevant radiation-induced abscopal effects in metastatic melanoma patients: A systematic review. Clinical and Translational Radiation Oncology 2018;9: P5–11Chandra RA, Wilhite TJ, Balboni TA, et al. A systematic evaluation of abscopal responses following radiotherapy in patients with metastatic melanoma treated with ipilimumab Oncoimmunology 2015; 4 (11):e1046028Chandra RA, Wilhite TJ, Balboni TA, et al. A systematic evaluation of abscopal responses following radiotherapy in patients with metastatic melanoma treated with ipilimumab Oncoimmunology 2015; 4 (11):e1046028Vanpouille-Box C, Alard A, Aryankalayil MJ, et al. DNA exonuclease Trex1 regulates radiotherapy-induced tumor immunogenicity. Nat Commun 2017;8:15618 DOI: 10.1038Vanpouille-Box C, Alard A, Aryankalayil MJ, et al. DNA exonuclease Trex1 regulates radiotherapy-induced tumor immunogenicity. Nat Commun 2017;8:15618 DOI: 10.1038Brooks ED, Chang JY. Time to abandon single-site irradiation for inducing abscopal effects. Nature Reviews 2019;16:123–135.Brooks ED, Chang JY. Time to abandon single-site irradiation for inducing abscopal effects. Nature Reviews 2019;16:123–135.US Department of Health & Human Services. CTCAE) v4.03. NIH. gov https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03/CTCAEUS Department of Health & Human Services. CTCAE) v4.03. NIH. gov https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03/CTCAETubin S, Popper HH, Brcic L. Novel stereotactic body radiation therapy (SBRT) — based partial tumor irradiation targeting hypoxic segment of bulky tumors (SBRT-PATHY): improvement of the radiotherapy outcome by exploiting the bystander and abscopal effects. Radiation Oncology 2019;14:21Tubin S, Popper HH, Brcic L. Novel stereotactic body radiation therapy (SBRT) — based partial tumor irradiation targeting hypoxic segment of bulky tumors (SBRT-PATHY): improvement of the radiotherapy outcome by exploiting the bystander and abscopal effects. Radiation Oncology 2019;14:21Zhang X., Niedermann G. OC - 0052: Abscopal effects with RT schedules extending to the effector phase of the antitumor T cell response. ESTRO 37 abstract book.Zhang X., Niedermann G. OC - 0052: Abscopal effects with RT schedules extending to the effector phase of the antitumor T cell response. ESTRO 37 abstract book.Marciscano AE, Ghasemzadeh A, Nirschl TR, et al. Elective nodal irradiation attenuates the combinatorial efficacy of stereotactic radiation therapy and immunotherapy. Clin Cancer Research 2018;;24 (20):5058–5071.Marciscano AE, Ghasemzadeh A, Nirschl TR, et al. Elective nodal irradiation attenuates the combinatorial efficacy of stereotactic radiation therapy and immunotherapy. Clin Cancer Research 2018;;24 (20):5058–5071.Ho AY, Barker CA, Arnold BB, et al. A Phase 2 Clinical Trial Assessing the Efficacy and Safety of Pembrolizumab and Radiotherapy in Patients with Metastatic Triple-Negative Breast Cancer. Cancer 2020;126:850–860Ho AY, Barker CA, Arnold BB, et al. A Phase 2 Clinical Trial Assessing the Efficacy and Safety of Pembrolizumab and Radiotherapy in Patients with Metastatic Triple-Negative Breast Cancer. Cancer 2020;126:850–860Nanda R, Chow LQM, Dees EC, et al. Pembrolizumab in Patients With Advanced Triple-Negative Breast Cancer: Phase Ib KEYNOTE - 012 Study. J Clin Oncol 2016, 34 (21):2460–2467Nanda R, Chow LQM, Dees EC, et al. Pembrolizumab in Patients With Advanced Triple-Negative Breast Cancer: Phase Ib KEYNOTE - 012 Study. J Clin Oncol 2016, 34 (21):2460–2467Adams S, Schmid P, Rugo HS, et al. Pembrolizumab monotherapy for previously treated metastatic triple-negative breast cancer: cohort A of the phase II KEYNOTE - 086 study. Ann Oncol 2019, 30 (3):397–404Adams S, Schmid P, Rugo HS, et al. Pembrolizumab monotherapy for previously treated metastatic triple-negative breast cancer: cohort A of the phase II KEYNOTE - 086 study. Ann Oncol 2019, 30 (3):397–404Adams S, Loi S, Toppmeyer D, et al. Pembrolizumab monotherapy for previously untreated, PD-L1‑positive, metastatic triple-negative breast cancer: cohort B of the phase II KEYNOTE - 086 study. Ann Oncol 2019, 30 (3):405–411Adams S, Loi S, Toppmeyer D, et al. Pembrolizumab monotherapy for previously untreated, PD-L1‑positive, metastatic triple-negative breast cancer: cohort B of the phase II KEYNOTE - 086 study. Ann Oncol 2019, 30 (3):405–411Voorwerk L, Slagter M, Horlings HM, et al. Immune induction strategies in metastatic triple-negative breast cancer to enhance the sensitivity to PD - 1 blockade: the TONIC trial. Nat Med 2019;25 (6):920–928Voorwerk L, Slagter M, Horlings HM, et al. Immune induction strategies in metastatic triple-negative breast cancer to enhance the sensitivity to PD - 1 blockade: the TONIC trial. Nat Med 2019;25 (6):920–928Barroso-Sousa R, Krop IE, Trippa L, et al. A Phase II Study of Pembrolizumab in Combination with Palliative Radiotherapy for Hormone Receptor-positive Metastatic Breast Cancer. Clinical Breast Cancer 2020, 20 (3):238–245Barroso-Sousa R, Krop IE, Trippa L, et al. A Phase II Study of Pembrolizumab in Combination with Palliative Radiotherapy for Hormone Receptor-positive Metastatic Breast Cancer. Clinical Breast Cancer 2020, 20 (3):238–245McBride S, Sherman E, Tsai CJ, et al. Randomized Phase II Trial of Nivolumab With Stereotactic Body Radiotherapy Versus Nivolumab Alone in Metastatic Head and Neck Squamous Cell Carcinoma. J Clin Oncol 2021;39 (1):30–37McBride S, Sherman E, Tsai CJ, et al. Randomized Phase II Trial of Nivolumab With Stereotactic Body Radiotherapy Versus Nivolumab Alone in Metastatic Head and Neck Squamous Cell Carcinoma. J Clin Oncol 2021;39 (1):30–37Theelen WSME, Peulen HMU, Lalezari F, et al. Effect of Pembrolizumab After Stereotactic Body Radiotherapy vs Pembrolizumab Alone on Tumor Response in Patients with Advanced Non-Small Cell Lung Cancer: Results of the PEMBRO-RT Phase 2 Randomized Clinical Trial. JAMA Oncology 2019;5 (9):1276–1282Theelen WSME, Peulen HMU, Lalezari F, et al. Effect of Pembrolizumab After Stereotactic Body Radiotherapy vs Pembrolizumab Alone on Tumor Response in Patients with Advanced Non-Small Cell Lung Cancer: Results of the PEMBRO-RT Phase 2 Randomized Clinical Trial. JAMA Oncology 2019;5 (9):1276–1282Welsh J, Menon H, Chen D, et al. Pembrolizumab with or without radiation therapy for metastatic non-small cell lung cancer: a randomized phase I / II trial. Journal for ImmunoTherapy of Cancer 2020;8: e001001Welsh J, Menon H, Chen D, et al. Pembrolizumab with or without radiation therapy for metastatic non-small cell lung cancer: a randomized phase I / II trial. Journal for ImmunoTherapy of Cancer 2020;8: e001001Theelen WSME, Chen D, Verma V, et al. Pembrolizumab with or without radiotherapy for metastatic non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Respir Med. 2020;20: S2213–2600Theelen WSME, Chen D, Verma V, et al. Pembrolizumab with or without radiotherapy for metastatic non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Respir Med. 2020;20: S2213–2600Herbst RS, Garon EB, Kim DW, et al. Long-Term Outcomes and Retreatment Among Patients with Previously Treated, Programmed Death-Ligand 1‒Positive, Advanced Non‒Small-Cell Lung Cancer in the KEYNOTE - 010 Study. J Clin Oncol 2020;38(14):1580-1590.Herbst RS, Garon EB, Kim DW, et al. Long-Term Outcomes and Retreatment Among Patients with Previously Treated, Programmed Death-Ligand 1‒Positive, Advanced Non‒Small-Cell Lung Cancer in the KEYNOTE - 010 Study. J Clin Oncol 2020;38(14):1580-1590.

The authors declare that there are no conflicts of interest present.