Radiotherapy (RT) has a fundamental role in the treatment of gynecologic malignancies, including cervical and uterine cancers. Hypofractionated RT has gained popularity in many cancer sites, boosted by technological advances in treatment delivery and image verification. Hypofractionated RT uptake was intensified during the COVID-19 pandemic and has the potential to improve universal access to radiotherapy worldwide, especially in low-resource settings. This review summarizes the rationale, the current challenges and investigation efforts, together with the recent developments associated with hypofractionated RT in gynecologic malignancies. A comprehensive search was undertaken using multiple databases and ongoing trial registries. In the definitive radiotherapy setting for cervical cancers, there are several ongoing clinical trials from Canada, Mexico, Iran, the Philippines and Thailand investigating the role of a moderate hypofractionated external beam RT regimen in the low-risk locally advanced population. Likewise, there are ongoing ultra and moderate hypofractionated RT trials in the uterine cancer setting. One Canadian prospective trial of stereotactic hypofractionated adjuvant RT for uterine cancer patients suggested a good tolerance to this treatment strategy in the acute setting, with a follow-up trial currently randomizing patients between conventional fractionation and the hypofractionated dose regimen delivered in the former trial. Although not yet ready for prime-time use, hypofractionated RT could be a potential solution to several challenges that limit access to and the utilization of radiotherapy for gynecologic cancer patients worldwide.
放射治疗在妇科恶性肿瘤（包括宫颈癌和子宫癌）的治疗中具有基础性作用。得益于治疗实施和影像验证技术的进步，大分割放疗已在多种癌症治疗中得到广泛应用。在新冠疫情期间，大分割放疗的应用进一步扩大，并有望在全球范围内提高放疗的可及性，特别是在资源匮乏地区。本综述总结了大分割放疗在妇科恶性肿瘤治疗中的理论基础、当前面临的挑战与研究进展，并梳理了相关最新发展动态。通过检索多个数据库及正在进行的临床试验注册平台，我们发现：在宫颈癌根治性放疗领域，加拿大、墨西哥、伊朗、菲律宾和泰国正在开展多项针对低危局部晚期宫颈癌患者的中度大分割外照射放疗方案的临床试验。同样，在子宫癌治疗领域也正在进行超分割与中度大分割放疗试验。一项加拿大前瞻性试验表明，子宫癌患者对立体定向大分割辅助放疗方案在急性期表现出良好耐受性，其后续试验正在将患者随机分组，分别接受常规分割放疗与前序试验采用的大分割剂量方案。尽管尚未达到成熟应用阶段，大分割放疗有望成为解决全球妇科癌症患者放疗可及性与利用率受限等挑战的潜在方案。
Hypofractionated Radiotherapy in Gynecologic Malignancies—A Peek into the Upcoming Evidence
肿瘤(癌症)患者之家