Shah Jennifer L, Loo Billy W
Department of Radiation Oncology and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA.
Department of Radiation Oncology and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA.
Semin Radiat Oncol. 2017 Jul;27(3):218-228. doi: 10.1016/j.semradonc.2017.03.001. Epub 2017 Mar 16.
The rising incidence of early-stage lung cancer, particularly in medically inoperable patients, is anticipated because of the implementation of early detection strategies and population aging in the United States and worldwide. This mandates the development of noninvasive curative treatment approaches for this disease. Stereotactic ablative radiotherapy (SABR) has recently emerged as a standard of care for early-stage lung cancer in medically inoperable patients who cannot safely tolerate surgical lobectomy, the established standard for operable patients. Further experience has demonstrated key principles with this highly conformal and dose-intensive radiation technique, including the need for sufficiently high biologically effective dose to achieve optimal local control, dose-fractionation modifications needed to treat centrally located tumors safely, and individualization of treatment based on tumor size, location, and other factors. SABR requires particular technical expertise including a nuanced understanding of dose prescription and calculation and appropriate management of tumor and organ motion. Progress continues as increasing experience with and data on SABR in selected cohorts of medically operable patients suggest comparable oncologic outcomes and a more favorable toxicity profile that challenges the historical standard of care for broader patient populations.
由于美国和全球范围内早期检测策略的实施以及人口老龄化，预计早期肺癌的发病率将会上升，尤其是在医学上无法进行手术的患者中。这就要求开发针对这种疾病的非侵入性治愈性治疗方法。立体定向消融放疗（SABR）最近已成为医学上无法进行手术且不能安全耐受手术肺叶切除术（可手术患者的既定标准）的早期肺癌患者的护理标准。进一步的经验已经证明了这种高度适形和剂量密集型放射技术的关键原则，包括需要足够高的生物有效剂量以实现最佳局部控制、安全治疗中心型肿瘤所需的剂量分割调整，以及根据肿瘤大小、位置和其他因素进行个体化治疗。SABR需要特定的技术专长，包括对剂量处方和计算的细微理解以及对肿瘤和器官运动的适当管理。随着在选定的可手术患者队列中对SABR的经验和数据不断增加，进展仍在继续，这表明其肿瘤学结果相当，毒性特征更有利，这对更广泛患者群体的历史护理标准提出了挑战。
