Terlizzi M, Limkin E, Sellami N, Louvel G, Blanchard P
Department of Radiation Oncology, Gustave Roussy Institute, 114 Rue Edouard Vaillant 94805 Villejuif, France.
Clin Transl Radiat Oncol. 2023 Jan 25;39:100584. doi: 10.1016/j.ctro.2023.100584. eCollection 2023 Mar.
Stereotactic Body Radiation Therapy (SBRT) is a standard of care for many localizations but the question of the optimal fractionation remains a matter of concern. If single fraction sessions are routinely used for intracranial targets, their utilization for mobile extracranial lesions is a source of debate and apprehension. Single session treatments improve patient comfort, provide a medico-economic benefit, and have proven useful in the context of the SARS-CoV 2 pandemic. However, both technical and radiobiological uncertainties remain. Experience from intracranial radiosurgery has shown that the size of the target, its proximity to organs at risk, tumor histology, and the volume of normal tissue irradiated are all determining factors in the choice of fractionation. The literature on the use of single fraction for extracranial sites is still scarce. Only primary and secondary pulmonary tumors have been evaluated in prospective randomized trials, allowing the integration of these fractionation schemes in daily practice, for highly selected cases and in trained teams. The level of evidence for the other organs is mainly based on dose escalation or retrospective trials and calls for caution, with further studies being needed before routine use in clinical practice.
立体定向体部放射治疗（SBRT）是许多部位的标准治疗方法，但最佳分割方案的问题仍然备受关注。如果单次分割治疗常规用于颅内靶点，那么将其用于移动性颅外病变则存在争议和担忧。单次治疗可提高患者舒适度，具有医学经济优势，并且在2019冠状病毒病大流行期间已证明是有用的。然而，技术和放射生物学方面的不确定性仍然存在。颅内放射外科的经验表明，靶区大小、其与危及器官的距离、肿瘤组织学以及受照射正常组织的体积都是分割方案选择的决定因素。关于颅外部位使用单次分割的文献仍然很少。只有原发性和继发性肺部肿瘤在前瞻性随机试验中得到了评估，这使得这些分割方案能够在日常实践中，针对高度选择的病例并在训练有素的团队中得以应用。其他器官的证据水平主要基于剂量递增或回顾性试验，需要谨慎对待，在临床实践中常规使用之前还需要进一步研究。
