Department of Radiation Oncology, Stanford University and Cancer Center, 875 Blake Wilbur Drive, Stanford, CA 94305-5847, USA.
Curr Treat Options Oncol. 2010 Jun;11(1-2):24-35. doi: 10.1007/s11864-010-0119-z.
Surgery is the standard of care for early stage non-small cell lung cancer (NSCLC), with lobectomy being the most oncologically sound resection. Medically inoperable patients and high-risk surgical candidates require effective alternatives to surgery; even operable patients may opt for less invasive options if they are proven to achieve similar outcomes to surgery. Minimally invasive local treatment modalities including dose-intensified conformal radiation therapy, most notably stereotactic ablative radiotherapy (SABR; also known as stereotactic body radiation therapy), and thermal ablation methods such as radiofrequency ablation (RFA) and microwave ablation (MWA) are emerging as promising treatment options whose roles in the treatment of early stage lung cancer are being defined. Early clinical experience and a rapidly growing body of prospective clinical trials, primarily in medically inoperable patients, are demonstrating encouraging effectiveness and safety outcomes in some cases approaching historical results with surgery. Given the very poor prognosis of the medically inoperable patient population, these alternatives to surgery, particularly SABR, are starting to be considered appropriate first-line therapy in properly selected patients, and prospective cooperative group trials to evaluate and optimize RFA and SABR in specific patient subsets are being conducted. For operable patients, prospective multi-center and cooperative groups trials of SABR are ongoing or completed, and international randomized trials of SABR vs. surgery have been initiated. Thus, promising alternatives to surgery for early stage NSCLC are ready for prime time evaluation in the setting of clinical trials, and participation in ongoing trials for both operable and medically inoperable patients is strongly encouraged.
手术是早期非小细胞肺癌（NSCLC）的标准治疗方法，肺叶切除术是最具肿瘤学意义的切除方法。不能手术的患者和高危手术患者需要有效的手术替代方法；即使是可手术的患者，如果有证据表明他们的治疗结果与手术相似，他们也可能选择更微创的方法。包括剂量递增适形放疗在内的微创局部治疗方法，尤其是立体定向消融放疗（SABR；也称为立体定向体部放疗）和热消融方法，如射频消融（RFA）和微波消融（MWA），正成为有前途的治疗选择，其在早期肺癌治疗中的作用正在得到定义。早期临床经验和大量不断增加的前瞻性临床试验，主要针对不能手术的患者，在某些情况下证明了令人鼓舞的有效性和安全性结果，这些结果在某些情况下接近手术的历史结果。鉴于不能手术的患者人群的预后非常差，这些手术替代方法，特别是 SABR，开始被认为是适当的一线治疗方法，适用于经过适当选择的患者，并且正在进行前瞻性合作组试验，以评估和优化特定患者亚组中的 RFA 和 SABR。对于可手术的患者，SABR 的前瞻性多中心和合作组试验正在进行或已经完成，SABR 与手术的国际随机试验已经启动。因此，早期非小细胞肺癌的手术替代方法已经准备好进行临床试验的评估，强烈鼓励可手术和不能手术的患者参加正在进行的试验。
