Department of Radiation Oncology, University of Arizona, 1501 N Campbell Ave., Tucson, AZ 85724, USA.
Radiother Oncol. 2010 Jan;94(1):1-11. doi: 10.1016/j.radonc.2009.12.008. Epub 2010 Jan 13.
To analyze the patterns of failure, the toxicity profile, and the factors influencing efficacy of stereotactic body radiation (SBRT) for early-stage non-small-cell lung cancer (NSCLC).
A search was based on PubMed electronic databases. All searches were conducted in May, 2009.
The local control ranged from 80% to 100% in most studies with adequate isocentric or peripheral biologically effective dose (BED). Recurrences were associated with increased tumor size. The main pattern of failure after SBRT was distant metastasis. Grades 3-5 toxicity occurred mostly in centrally located tumors, and adjuvant chemotherapy may further decrease all recurrences; possibly translating to a survival benefit in large or centrally located tumors where high BED cannot be safely reached.
SBRT is an excellent treatment option for early-stage, and mostly medically inoperable, NSCLC. BED at both the isocenter and the tumor periphery is very important for optimal tumor control; higher doses are required for large (T2) lesions; SBRT for centrally located tumors can be feasible with a much less aggressive dose regimen than 60-66Gy/3 fractions and adjacent critical structures excluded from the target volume; chemotherapy may optimize the clinical outcome in large or centrally located lesions.
分析立体定向体部放射治疗（SBRT）早期非小细胞肺癌（NSCLC）的失败模式、毒性概况以及影响疗效的因素。
基于 PubMed 电子数据库进行搜索。所有搜索均于 2009 年 5 月进行。
在大多数等中心或外周生物有效剂量（BED）充足的研究中，局部控制率为 80%至 100%。复发与肿瘤增大有关。SBRT 后的主要失败模式为远处转移。位于中央的肿瘤易发生 3-5 级毒性，辅助化疗可能进一步降低所有复发；在大肿瘤或中央肿瘤中，高 BED 无法安全达到时，可能会转化为生存获益，这些肿瘤通常无法手术治疗。
SBRT 是早期、大多数不能手术的 NSCLC 的极好治疗选择。等中心和肿瘤外周的 BED 对最佳肿瘤控制非常重要；大（T2）病变需要更高剂量；对于中央肿瘤，排除靶区相邻重要结构后，采用比 60-66Gy/3 个分次照射剂量更具侵袭性的方案也可行；化疗可能优化大肿瘤或中央肿瘤的临床转归。
