Vlaskou Badra Eugenia, Baumgartl Michael, Fabiano Silvia, Jongen Aurélien, Guckenberger Matthias
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Transl Lung Cancer Res. 2021 Apr;10(4):1930-1949. doi: 10.21037/tlcr-20-860.
Stereotactic body radiation therapy (SBRT) allows for the non-invasive and precise delivery of ablative radiation dose. The use and availability of SBRT has increased rapidly over the past decades. SBRT has been proven to be a safe, effective and efficient treatment for early stage non-small cell lung cancer (NSCLC) and is presently considered the standard of care in the treatment of medically or functionally inoperable patients. Evidence from prospective randomized trials on the optimal treatment of patients deemed medically operable remains owing, as three trials comparing SBRT to surgery in this cohort were terminated prematurely due to poor accrual. Yet, SBRT in early stage NSCLC is associated with favorable toxicity profiles and excellent rates of local control, prompting discussion in regard of the treatment of medically operable patients, where the standard of care currently remains surgical resection. Although local control in early stage NSCLC after SBRT is high, distant failure remains an issue, prompting research interest to the combination of SBRT and systemic treatment. Evolving advances in SBRT technology further facilitate the safe treatment of patients with medically or anatomically challenging situations. In this review article, we discuss international guidelines and the current standard of care, ongoing clinical challenges and future directions from the clinical and technical point of view.
立体定向体部放射治疗（SBRT）能够实现非侵入性且精确地给予消融性辐射剂量。在过去几十年中，SBRT的使用和可及性迅速增加。SBRT已被证明是早期非小细胞肺癌（NSCLC）的一种安全、有效且高效的治疗方法，目前被认为是治疗医学上或功能上无法手术的患者的标准治疗手段。关于医学上可手术患者的最佳治疗方法，前瞻性随机试验的证据仍然不足，因为在这一队列中比较SBRT与手术的三项试验因入组不佳而提前终止。然而，早期NSCLC的SBRT具有良好的毒性特征和出色的局部控制率，这引发了对于医学上可手术患者治疗的讨论，目前该类患者的标准治疗仍然是手术切除。尽管SBRT后早期NSCLC的局部控制率很高，但远处转移仍然是一个问题，这激发了对SBRT与全身治疗联合应用的研究兴趣。SBRT技术的不断进步进一步促进了对医学上或解剖学上具有挑战性情况的患者的安全治疗。在这篇综述文章中，我们从临床和技术角度讨论国际指南和当前的标准治疗方法、持续存在的临床挑战以及未来方向。
