Роль лучевой терапии в лечении больных мезотелиомой плевры

Борисова Т.Н., Ткачев С.И., Иванов С.М. и др. Роль лучевой терапии в лечении больных мезотелиомой плевры. Современная Онкология. 2020; 22 (4): 109–114. DOI: 10.26442/18151434.2020.4.200255

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Borisova T.N., Tkachev S.I., Ivanov S.M. et al. The role of radiation therapy in the treatment of patients with pleural mesothelioma. Journal of Modern Oncology. 2020; 22 (4): 109–114. DOI: 10.26442/18151434.2020.4.200255

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Аннотация

Мезотелиома плевры (МП) остается заболеванием с плохим прогнозом, несмотря на использование последних достижений мультимодального лечения. Лучевая терапия (ЛТ) при МП традиционно используется в нескольких направлениях: в радикальном лечении как часть трехмодального подхода, для снижения риска метастазирования на грудной стенке в местах инвазивных вмешательств и в паллиативном лечении. Недостаток надежных рандомизированных исследований привел к отсутствию консенсуса относительно оптимальной радикальной стратегии лечения. Современные мировые рекомендации по лечению МП противоречивы в отношении использования адъювантной радиотерапии в мультимодальном лечении. Хотя роль ЛТ в лечении МП остается неясной, значительные успехи в ее планировании и проведении показывают, что длительная выживаемость может быть достигнута у тех пациентов, для которых до недавнего времени считалось целесообразным только паллиативное лечение. Профилактическое облучение зон инвазивных вмешательств много лет используется как способ профилактики имплантационного метастазирования. Однако ряд рандомизированных исследований и недавний метаанализ не продемонстрировали пользы от данного лечебного подхода. В связи с редкостью МП, тяжелым статусом пациентов, локализацией опухоли значение ЛТ в паллиативном лечении больных МП остается неоднозначным. Недавние завершенные и запланированные исследования позволяют положительно оценить роль паллиативного облучения и рекомендовать его с целью снижения болевого синдрома.

Ключевые слова: мезотелиома плевры, лучевая терапия, адъювантная радиотерапия в мультимодальном лечении, профилактическое облучение зон инвазивных вмешательств.

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Pleural mesothelioma (PM) remains a disease with a poor prognosis, despite the use of the newest achievements of multimodal treatment. Radiation therapy for PM is traditionally used in some directions: in radical treatment as a part of a three-modal approach, for reducing the risk of chest metastasis in areas of invasive interventions and during palliative treatment. The lack of reliable randomized trials has led to an absence of consensus about the optimal radical treatment strategy. Mordern global recommendations for the treatment of PM are controversial regarding the use of adjuvant radiotherapy in multimodal treatment. Although the role of radiation therapy in the treatment of PM remains unclear, significant successes in planning and conducting radiotherapy are showing that long-term survival can be achieved for these patients, for whom, until recently, only palliative treatment was considered as appropriate treatment. For many years, preventive irradiation of areas of invasive interventions has been used as a method to prevent implantation metastasis. However, a number of randomized trials and recent meta-analysis have not demonstrated the benefits of this treatment approach. Due to the rarity of PM, the severe state of patients and tumor localization, the importance of radiation therapy in the palliative treatment of patients with pleural mesothelioma remains controversial. Recent completed and planned studies allow to commend the role of palliative radiation and recommend it in order to reduce pain.

Key words: pleural mesothelioma, radiation therapy, adjuvant radiotherapy in multimodal treatment, prophylactic irradiation of invasive intervention zones.

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Авторы

Т.Н. Борисова*, С.И. Ткачев, С.М. Иванов, С.Б. Алиева, О.П. Трофимова, В.В. Глебовская, В.В. Бредер, К.К. Лактионов, Д.Т. Маринов, А.Г. Абдуллаев

ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России, Москва, Россия
*tborisova111@gmail.com

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Tatiana N. Borisova*, Sergey I. Tkachev, Stanislav M. Ivanov, Sevil B. Alieva, Oxana P. Trofimova, Valeria V. Glebovskaya, Valeriy V. Breder, Konstantin K. Laktionov, Dimitr T. Marinov, Amir G. Abdullaev

Blokhin National Medical Research Center of Oncology, Moscow, Russia
*tborisova111@gmail.com

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