Academic Radiation Oncology Department, University Lille II Oscar Lambret Comprehensive Cancer Center, 3, rue Frederic-Combemale, BP 307, 59020 Lille cedex, France.
Diagn Interv Imaging. 2013 Mar;94(3):255-62. doi: 10.1016/j.diii.2012.06.006. Epub 2012 Dec 29.
Stereotactic radiation therapy (SRT) is becoming more and more important in the treatment of inoperable patients with early stages of pulmonary carcinomas (T1-T2 N0M0). In certain cases, evaluation of the response is still problematical and it can be difficult to differentiate response from progression. The aim of this paper is to set out these various changes and to produce a protocol for optimal monitoring. By comparing our clinical experience with data from the literature, the main visual aspects on a CT scan are set out and illustrated for each clinical situation: radiation pneumonitis, radiation fibrosis, therapeutic response and progression. The literature was reviewed by querying the main databases and selecting papers concerning pulmonary SRT and post-therapeutic radiological appearance. CT appearance induced by SRT differs significantly from images after classic conformal radiation therapy, both morphologically and chronologically. In particular, the modifications induced by stereotactic radiation therapy are only seen in a limited volume surrounding the volume treated. Knowledge of the radiological criteria necessary to differentiate between a therapeutic response and recurrence is of major importance in the present context of increase in use of this technique.
立体定向放射治疗（SRT）在治疗无法手术的早期肺癌（T1-T2 N0M0）患者中变得越来越重要。在某些情况下，对疗效的评估仍然存在问题，很难将疗效与进展区分开来。本文旨在阐述这些不同的变化，并制定出最佳监测方案。通过比较我们的临床经验和文献数据，列出了每种临床情况的主要 CT 扫描上的视觉表现，并举例说明：放射性肺炎、放射性纤维化、治疗反应和进展。通过查询主要数据库并选择有关肺部 SRT 和治疗后放射学表现的论文，对文献进行了回顾。SRT 引起的 CT 表现与经典适形放射治疗后的图像在形态和时间上均有显著差异。特别是，立体定向放射治疗引起的改变仅在治疗区域周围的有限体积内可见。在当前这项技术应用日益增加的背景下，了解区分治疗反应和复发所需的放射学标准具有重要意义。
