دانلود کتاب پرتودرمانی استریوتاکتیک بدن و پرتودرمانی استریوتاکتیک تخریبی برای سرطان‌ها

While systemic treatments (chemotherapy, targeted therapies, hormonal therapies, immunotherapies, etc.) are the standard-of-care of synchronous metastatic cancers, local treatment of the primary tumors by surgery or radiotherapy (RT) was mainly used as palliative or symptomatic management (pain, bleeding, etc.). The progress of systemic treatments in recent years has changed the prognosis of these patients, with significantly prolonged survival [1] and sometimes achieved complete remission for several years. This raised the question of treatment of the primary tumors. For some primary diseases, locoregional therapy (LRT) for the intact primary tumor has been hypothesized to improve overall survival (OS), but retrospective series and clinical trials have reported conflicting results. Pooling the data from 4952 patients with various histology subtypes, of whom 1558 received RT and 912 surgery, Ryckman et al. did not find a benefit in progression-free survival (PFS) nor overall survival (OS) [2]. Local treatment of the primary was associated in an OS benefit but only in low metastatic burden patients (HR 0.67, 95% CI 0.52–0.85) while surgery did not improve OS whatever the metastatic burden. When sub-analyzing the results, differential responses may appear depending on the primary and histology. This article thus provides an update on the role of RT on the primary tumors in breast, prostate, and lung cancers with synchronous oligometastatic or oligopersistent disease, and discusses its value through published or ongoing trials.