Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA.
Ann Transl Med. 2015 Aug;3(13):172. doi: 10.3978/j.issn.2305-5839.2015.07.26.
Lobectomy has been the standard of care for patients with early stage non-small cell lung cancer (NSCLC), resulting in nearly universal local control and excellent overall survival. However, up to one-quarter of early stage patients are unable to undergo or refuse definitive resection. With the increasing adoption of stereotactic ablative radiotherapy (SABR) over conventionally fractionated radiotherapy among medical inoperable patients, tumor control and overall survival rates in this population have significantly improved. Trials demonstrating excellent outcomes among both medically inoperable and medical operable patients with stage I NSCLC have spurred interest in comparisons between surgery and SABR. The recent publication of the randomized STARS and ROSEL trials demonstrated fewer toxicities and an improvement in overall survival among patients treated with SABR compared with surgery. Based on these trials and retrospective comparisons between the modalities, definitive SABR now more firmly appears to be a viable first-line option for treating patients with operable stage I NSCLC.
肺叶切除术一直是早期非小细胞肺癌（NSCLC）患者的标准治疗方法，几乎可以实现完全局部控制和良好的总体生存率。然而，多达四分之一的早期患者无法进行或拒绝确定性切除。随着立体定向消融放疗（SABR）在无法手术的患者中比常规分割放疗的应用越来越广泛，这部分患者的肿瘤控制和总生存率显著提高。在无法手术和可手术的 I 期 NSCLC 患者中，临床试验均显示出优异的结果，这激发了人们对手术和 SABR 之间进行比较的兴趣。最近发表的随机 STARS 和 ROSEL 试验表明，与手术相比，SABR 治疗的患者毒性更少，总生存率提高。基于这些试验和两种治疗方法的回顾性比较，明确的 SABR 现在似乎更像是治疗可手术的 I 期 NSCLC 患者的可行一线选择。
