Аннотация
В статье представлены результаты голосования консенсуса экспертов по использованию режимов гипофракционирования дозы у больных со злокачественными новообразованиями различных локализаций, посвященного наиболее актуальным и спорным вопросам лучевого лечения опухолей головного мозга, головы и шеи, рака молочной железы, прямой кишки и предстательной железы.
В консенсусе приняли участие 46 ведущих экспертов в области лучевой терапии злокачественных новообразований различных локализаций, проголосовавшие в ходе прямого эфира по 14 вопросам, разделенным на пять блоков. Учитывая возможность использования результатов экспертного голосования при составлении клинических рекомендаций, консенсус считался достигнутым только при 70 %-ном и более совпадении голосов.
Библиографические ссылки
Malmström A., Grønberg B.H., Marosi C., et al. Temozolo-mide versus standard 6-week radiotherapy versus hypofrac-tionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol. 2012; 13(9): 916-26.-DOI: https://doi.org/10.1016/S1470-2045(12)70265-6.
Roa W., Kepka L., Narendra Kumar N., et al. International Atomic Energy Agency randomized phase III study of radiation therapy in elderly and/or frail patients with newly diagnosed glioblastoma multiforme. J Clin Oncol. 2015; 10; 33(35): 4145-50.-DOI: https://doi.org/10.1200/JCO.2015.62.6606.
Чугуев А.С., Герасимов В.А., Каприн А.Д., Даценко П.В. Результаты исследования двух режимов фракционирования при глиомах 4 степени злока-чественности. Вопросы онкологии. 2025; 71(5): 995-1003.-DOI: https://doi.org/10.37469/0507-3758-2025-71-5-OF-2206. [Chuguev A.S., Gerasimov V.A., Kaprin A.D., Datsenko P.V. Results of the study of two fractionation regimens in grade 4 gliomas. Voprosy Onkologii = Problems in Oncology. 2025; 71(5): 995-1003.-DOI: https://doi.org/10.37469/0507-3758-2025-71-5-OF-2206 (In Rus)].
Hingorani M., Colley W.P., Dixit S., Beavis A.M. Hypofrac-tionated radiotherapy for glioblastoma: strategy for poor-risk patients or hope for the future? Br J Radiol. 2012; 85(1017): 770-781.-DOI: https://doi.org/10.1259/bjr/83827377.
Perlow H.K., Prasad R.N., Yang M., et al. Accelerated hypofractionated radiation for elderly or frail patients with a newly diagnosed glioblastoma: A pooled analysis of patient-level data from 4 prospective trials. Cancer. 2022; 128(12): 2367-2374.-DOI: https://doi.org/10.1002/cncr.34192.
Liao G., Zhao Z., Yang H., Li X. Efficacy and safety of hypofractionated radiotherapy for the treatment of newly diagnosed glioblastoma multiforme: A systematic review and meta-analysis. Front Oncol. 2019; 9: 1017.-DOI: https://doi.org/10.3389/fonc.2019.01017.
Ziu M., Kim B.Y.S., Jiang W., et al. The role of radiation therapy in treatment of adults with newly diagnosed glioblastoma multiforme: a systematic review and evidence-based clinical practice guideline update. J Neurooncol. 2020; 150(2): 215-267.-DOI: https://doi.org/10.1007/s11060-020-03612-7.
Marcu L.G. Radiation therapy fractionation in the modern era of head and neck oncology towards an improved therapeutic window. Academia Oncology. 2024; 1.-DOI: https://doi.org/10.20935/AcadOnco7352.
Eom K.Y. Hypofractionated radiation therapy for head and neck cancers in the era of intensity-modulated radiation therapy. Radiat Oncol J. 2024; 42(1): 1-3.-DOI: https://doi.org/10.3857/roj.2024.00178.
Gupta T., Ghosh-Laskar S., Agarwal J.P. Resource-sparing curative-intent hypofractionated-accelerated radiotherapy in head and neck cancer: More relevant than ever before in the COVID era. Oral Oncol. 2020; 111: 105045.-DOI: https://doi.org/10.1016/j.oraloncology.2020.105045.
Frykholm G.J., Glimelius B., Påhlman L. Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum. 1993; 36(6): 564-572.-DOI: https://doi.org/10.1007/BF02049863.
Swedish Rectal Cancer Trial, Cedermark B., Dahlberg M., et al. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997; 336(14): 980-987.-DOI: https://doi.org/10.1056/NEJM199704033361402.
Bujko K., Nowacki M.P., Nasierowska-Guttmejer A., et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg. 2006; 93(10): 1215-1223.-DOI: https://doi.org/10.1002/bjs.5506.
Ngan S.Y., Burmeister B., Fisher R.J., et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol. 2012; 30(31): 3827-3833.-DOI: https://doi.org/10.1200/JCO.2012.42.9597.
Erlandsson J., Lörinc E., Ahlberg M., et al. Tumour regression after radiotherapy for rectal cancer — Results from the randomised Stockholm III trial. Radiother Oncol. 2019; 135: 178-186.-DOI: https://doi.org/10.1016/j.radonc.2019.03.016.
Ciseł B., Pietrzak L., Michalski W., et al. Long-course preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: long-term results of the randomized Polish II study. Ann Oncol. 2019; 30(8): 1298-1303.-DOI: https://doi.org/10.1093/annonc/mdz186.
Bahadoer R.R., Dijkstra E.A., van Etten B., et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021; 22(1): 29-42.-DOI: https://doi.org/10.1016/S1470-2045(20)30555-6.
Jin J., Tang Y., Hu C., et al. Multicenter, randomized, phase III trial of short-term radiotherapy plus chemotherapy versus long-term chemoradiotherapy in locally advanced rectal cancer (STELLAR). J Clin Oncol. 2022; 40(15): 1681-1692.-DOI: https://doi.org/10.1200/JCO.21.01667.
Ищанов Д.Г., Черных М.В., Иванов В.А., et al. Сравнение непосредственных результатов неоадъювантной дистанционной лучевой терапии больных раком прямой кишки в период пандемии новой коронавирусной инфекции. Многоцентровое ретроспективное исследование с использованием псевдорандомизации. Вопросы онкологии. 2025; 71(5): OF–2380.-DOI: https://doi.org/10.37469/0507-3758-2025-71-5-OF-2380. Ichshanov D.G., Cherhykh M.V., Ivanov V.A., et al. Comparison of immediate out-comes of neoadjuvant radiotherapy for rectal cancer during the COVID-19 pandemic. A propensity score-matched multicenter retrospective study. Voprosy Onkologii = Problems in Oncology. 2025; 71(5): OF–2380.-DOI: https://doi.org/10.37469/0507-3758-2025-71-5-OF-2380 (In Rus)].
Patel A., Spychalski P., Corrao G., et al. Neoadjuvant short-course radiotherapy with consolidation chemotherapy for locally advanced rectal cancer: a systematic review and meta-analysis. Acta Oncol. 2021; 60(10): 1308-1316.-DOI: https://doi.org/10.1080/0284186X.2021.1953137.
Giunta E.F., Bregni G., Pretta A., et al. Total neoadjuvant therapy for rectal cancer: Making sense of the results from the RAPIDO and PRODIGE 23 trials. Cancer Treat Rev. 2021; 96: 102177.-DOI: https://doi.org/10.1016/j.ctrv.2021.102177.
Dijkstra E.A., Nilsson P.J., Hospers G.A.P., et al. Locoregional failure during and after short-course radiotherapy followed by chemotherapy and surgery compared with long-course chemoradiotherapy and surgery: A 5-year follow-up of the RAPIDO trial. Ann Surg. 2023; 278(4): e766-e772.-DOI: https://doi.org/10.1097/SLA.0000000000005799.
Bercz A., Park B.K., Pappou E., et al. Organ preservation after neoadjuvant long-course chemoradiotherapy versus short-course radiotherapy. Ann Oncol. 2024; 35(11): 1003-1014.-DOI: https://doi.org/10.1016/j.annonc.2024.07.729.
Socha J., Kairevice L., Kępka L., et al. Should short-course neoadjuvant radiation therapy be applied for low-lying rectal cancer? A systematic review and meta-analysis of the randomized trials. Int J Radiat Oncol Biol Phys. 2020; 108(5): 1257-1264.-DOI: https://doi.org/10.1016/j.ijrobp.2020.06.077.
Whelan T., MacKenzie R., Julian J., et al. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst. 2002; 94(15): 1143-1150.-DOI: https://doi.org/10.1093/jnci/94.15.1143.
Whelan T.J., Pignol J.P., Levine M.N., et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010; 362(6): 513-520.-DOI: https://doi.org/10.1056/NEJMoa0906260.
START Trialists' Group, Bentzen S.M., Agrawal R.K., et al. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol. 2008; 9(4): 331-341.-DOI: https://doi.org/10.1016/S1470-2045(08)70077-9.
START Trialists' Group, Bentzen S.M., Agrawal R.K., et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: A randomised trial. Lancet. 2008; 371(9618): 1098-1107.-DOI: https://doi.org/10.1016/S0140-6736(08)60348-7.
Smith B.D., Bentzen S.M., Correa C.R., et al. Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Int J Radiat Oncol Biol Phys. 2011; 81(1): 59-68.-DOI: https://doi.org/10.1016/j.ijrobp.2010.04.042.
Offersen B.V., Alsner J., Nielsen H.M., et al. Hypofractionated versus standard fractionated radiotherapy in patients with early breast cancer or ductal carcinoma in situ in a randomized phase III trial: The DBCG HYPO trial. J Clin Oncol. 2020; 38(31): 3615-3625.-DOI: https://doi.org/10.1200/JCO.20.01363.
Wang S.L., Fang H., Song Y.W., et al. Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer: a randomised, non-inferiority, open-label, phase 3 trial. Lancet Oncol. 2019; 20(3): 352-360.-DOI: https://doi.org/10.1016/S1470-2045(18)30813-1.
Brion T., Ghodssighassemabadi R., Auzac G., et al. Early toxicity of moderately hypofractionated radiation therapy in breast cancer patients receiving locoregional irradiation: First results of the UNICANCER HypoG-01 phase III trial. Radiother Oncol. 2025; 207: 110849.-DOI: https://doi.org/10.1016/j.radonc.2025.110849.
Kishan A.U., Sun Y., Tree A.C., et al. Hypofractionated radiotherapy for prostate cancer (HYDRA): an individual patient data meta-analysis of randomised trials in the MARCAP consortium. Lancet Oncol. 2025; 26(4): 459-469.-DOI: https://doi.org/10.1016/S1470-2045(25)00034-8.
Widmark A., Gunnlaugsson A., Beckman L., et al. Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial. Lancet. 2019; 394(10196): 385-395.-DOI: https://doi.org/10.1016/S0140-6736(19)31131-6.
Dearnaley D., Syndikus I., Mossop H., et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2016; 17(8): 1047-1060.-DOI: https://doi.org/10.1016/S1470-2045(16)30102-4.
van As N., Griffin C., Tree A., et al. Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer. N Engl J Med. 2024; 391(15): 1413-1425.-DOI: https://doi.org/10.1056/NEJMoa2403365.
Lehrer E.J., Kishan A.U., Yu J.B., et al. Ultrahypofractionated versus hypofractionated and conventionally fractionated radiation therapy for localized prostate cancer: A systematic review and meta-analysis of phase III randomized trials. Radiother Oncol. 2020; 148: 235-242.-DOI: https://doi.org/10.1016/j.radonc.2020.04.037.
Draulans C., Haustermans K., Pos F.J., et al. Stereotactic body radiotherapy with a focal boost to the intraprostatic tumor for intermediate and high risk prostate cancer: 5-year efficacy and toxicity in the hypo-FLAME trial. Radiother Oncol. 2024; 201: 110568.-DOI: https://doi.org/10.1016/j.radonc.2024.110568.
Mohamad O., Zamboglou C., Zilli T., et al. Safety of ultrahypofractionated pelvic nodal irradiation in the definitive management of prostate cancer: systematic review and meta-analysis. Int J Radiat Oncol Biol Phys. 2024; 118(4): 998-1010.-DOI: https://doi.org/10.1016/j.ijrobp.2023.09.053.
Murthy V., Mallick I., Maitre P., et al. Pelvic regional control with 25 Gy in 5 fractions in stereotactic radiation therapy for high-risk prostate cancer: Pooled prospective outcomes from the SHARP consortium. Int J Radiat Oncol Biol Phys. 2025; 122(1): 93-98.-DOI: https://doi.org/10.1016/j.ijrobp.2024.12.018.
Самарцева Е.Е., Новиков С.Н., Ильин Н.Д., et al. Использование режима умеренного гипофракционирования дозы при облучении тазовых лимфатических узлов у больных раком предстательной железы высокого и очень высокого риска рецидива: предварительные результаты. Вопросы онкологии. 2025; 71(5): 1070-1081.-DOI: https://doi.org/10.37469/0507-3758-2025-71-5-of-2451. [Smartseva E.E., Novikov S.N., Ilyin N.D., et al. Moderate hypofractionation of dose in pelvic lymph node ir-radiation for patients with high and very high risk prostate cancer: preliminary results. Voprosy Onkologii = Problems in Oncology. 2025; 71(5): 1070-1081.-DOI: https://doi.org/10.37469/0507-3758-2025-71-5-of-2451 (In Rus)].

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