Department of Radiation Oncology, VU University medical center, Amsterdam, the Netherlands;
J Thorac Dis. 2011 Sep;3(3):189-96. doi: 10.3978/j.issn.2072-1439.2011.05.03.
Stereotactic ablative radiotherapy (SABR) is a technique that has rapidly entered routine care for early-stage peripheral non-small cell lung cancer in many countries in the last decade. The adoption of SABR was partly stimulated by advances in the so-called 'image guided' radiotherapy delivery. In the last 2 years, a growing body of publications has reported on clinical outcomes, acute and late radiological changes after SABR, and sub-acute and late toxicity. The local control rates in many publications have exceeded 90% when tumors of up to 5 cm have been treated, with corresponding regional nodal failure rates of approximately 10%. However, these results are not universal: lower control rates reported by some authors serve to emphasize the importance of quality assurance in all steps of SABR treatment planning and delivery. High-grade toxicity is uncommon when so-called 'risk-adapted' fractionation schemes are applied; an approach which involves the use of lower daily doses and more fractions when critical normal organs are in the proximity of the tumor volume. This review will address the new data available on a number of controversial topics such as the treatment of patients without a tissue diagnosis of malignancy, data on SABR outcomes in patients with severe chronic obstructive airways disease, use of a classification system for late radiological changes post-SABR, late treatment-related toxicity, and the evidence to support a need for expert multi-disciplinary teams in the follow-up of such patients.
立体定向消融放疗（SABR）是一种技术，在过去十年中，它在许多国家迅速成为早期周围性非小细胞肺癌的常规治疗方法。SABR 的采用部分受到所谓的“图像引导”放疗的推动。在过去的两年中，越来越多的出版物报道了 SABR 后的临床结果、急性和晚期影像学变化以及亚急性和晚期毒性。在治疗最大直径达 5 厘米的肿瘤时，许多出版物中的局部控制率超过 90%，相应的区域淋巴结失败率约为 10%。然而，这些结果并非普遍适用：一些作者报告的较低控制率强调了 SABR 治疗计划和实施的所有步骤中质量保证的重要性。当应用所谓的“风险适应”分割方案时，高级别毒性并不常见；这种方法涉及在肿瘤体积附近有重要的正常器官时使用较低的每日剂量和更多的分割。本综述将讨论一些有争议的话题的新数据，例如治疗没有恶性组织诊断的患者、SABR 结果数据在严重慢性阻塞性气道疾病患者中的应用、SABR 后晚期影像学变化的分类系统的使用、晚期治疗相关毒性以及支持多学科专家团队在这类患者的随访中的必要性的证据。
