Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
Lung Cancer. 2023 Aug;182:107284. doi: 10.1016/j.lungcan.2023.107284. Epub 2023 Jun 25.
A systematic review of treatment characteristics, outcomes, and treatment-related toxicities of stereotactic body radiation therapy (SBRT) for pulmonary oligometastases served as the basis for development of this International Stereotactic Radiosurgery Society (ISRS) practice guideline.
In accordance with PRISMA guidelines, a systematic review was performed of retrospective series with ≥50 patients/lung metastases, prospective trials with ≥25 patients/lung metastases, analyses of specific high-risk situations, and all randomized trials published between 2012 and July 2022 in the MEDLINE or Embase database using the key words "lung oligometastases", "lung metastases", "pulmonary metastases", "pulmonary oligometastases", "stereotactic body radiation therapy (SBRT)" and "stereotactic ablative body radiotherapy (SBRT)". Weighted random effects models were used to calculate pooled outcomes estimates.
Of the 1884 articles screened, 35 analyses (27 retrospective-, 5 prospective, and 3 randomized trials) reporting on treatment of >3600 patients and >4650 metastases were included. The median local control was 90 % (Range: 57-100 %) at 1 year and 79 % (R: 70-96 %) at 5 years. Acute toxicity ≥3 was reported for 0.5 % and late toxicity ≥3 for 1.8 % of patients. A total of 21 practice recommendations covering the areas of staging & patient selection (n = 10), SBRT treatment (n = 10), and follow-up (n = 1) were developed, with agreements rates of 100 %, except for recommendation 13 (83 %).
SBRT represents an effective definitive local treatment modality combining high local control rates with low risk of radiation-induced toxicities.
对立体定向体部放射治疗（SBRT）治疗肺寡转移瘤的治疗特点、结果和与治疗相关的毒性进行系统评价，为国际立体定向放射外科协会（ISRS）制定本实践指南提供依据。
根据 PRISMA 指南，对≥50 例/肺转移灶的回顾性系列研究、≥25 例/肺转移灶的前瞻性试验、特定高危情况的分析以及 2012 年至 2022 年 7 月在 MEDLINE 或 Embase 数据库中发表的所有随机试验进行了系统评价，使用的关键词是“肺寡转移瘤”、“肺转移灶”、“肺转移”、“肺寡转移”、“立体定向体部放射治疗（SBRT）”和“立体定向消融体放射治疗（SBRT）”。使用加权随机效应模型计算汇总结果估计值。
在筛选出的 1884 篇文章中，有 35 项分析（27 项回顾性、5 项前瞻性和 3 项随机试验）报告了超过 3600 例患者和超过 4650 个转移灶的治疗情况。1 年时的局部控制中位数为 90%（范围：57-100%），5 年时为 79%（范围：70-96%）。报告了 0.5%的患者发生≥3 级急性毒性，1.8%的患者发生≥3 级晚期毒性。共制定了 21 项涵盖分期和患者选择（n=10）、SBRT 治疗（n=10）和随访（n=1）领域的实践建议，除建议 13（83%）外，其余建议的达成率均为 100%。
SBRT 是一种有效的确定性局部治疗方法，具有较高的局部控制率和较低的放射性毒性风险。
