Park Henry S, Rimner Andreas, Amini Arya, Chang Joe Y, Chun Stephen G, Donington Jessica, Edelman Martin J, Gubens Matthew A, Higgins Kristin A, Iyengar Puneeth, Juloori Aditya, Movsas Benjamin, Nemeth Zsuzsanna, Ning Matthew S, Rodrigues George, Wolf Andrea, Simone Charles B
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
Department of Radiation Oncology, University of Freiberg, Freiburg im Breisgau, Baden-Württemberg, Germany.
J Thorac Oncol. 2024 Dec;19(12):1640-1653. doi: 10.1016/j.jtho.2024.09.1386. Epub 2024 Sep 11.
Definitive radiation therapy is considered standard therapy for medically inoperable early-stage NSCLC. Nevertheless, for patients with tumors located near structures such as the proximal tracheobronchial tree, esophagus, heart, spinal cord, and brachial plexus, the optimal management regimen is controversial. The objective was to develop expert multidisciplinary consensus guidelines on managing medically inoperable NSCLC located in a central or ultracentral location relative to critical organs at risk.
Case variants regarding centrally and ultracentrally located lung tumors were developed by the 15-member multidisciplinary American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) expert panel. A comprehensive review of the English medical literature was performed from January 1 1946 to December 31 2023 to inform consensus guidelines. Modified Delphi methods were used by the panel to evaluate the variants and procedures, with at least three rating points from median defining agreement/consensus. The guideline was then approved by the ARS Executive Committee and released for public comment per established ARS procedures.
The Thoracic ARS AUC Panel identified 90 relevant references and obtained consensus in all variants. Radiotherapy alone was considered appropriate, with additional immunotherapy to be considered primarily in the clinical trial setting. Hypofractionated radiotherapy in eight to 18 fractions was considered appropriate for ultracentral lesions near the proximal tracheobronchial tree, upper trachea, and esophagus. For other ultracentral lesions near the heart, great vessels, brachial plexus, and spine, or for non-ultracentral but still central lesions, five-fraction stereotactic body radiation therapy was also considered an appropriate option. Intensity-modulated radiotherapy was considered appropriate and three-dimensional-conformal radiotherapy inappropriate for all variants. Other treatment planning techniques to decrease the risk of overdosing critical organs at risk were also considered.
The ARS Thoracic AUC panel has developed multidisciplinary consensus guidelines for various presentations of stage I NSCLC in a central or ultracentral location.
对于医学上无法手术的早期非小细胞肺癌（NSCLC），确定性放射治疗被视为标准治疗方法。然而，对于肿瘤位于近端气管支气管树、食管、心脏、脊髓和臂丛神经等结构附近的患者，最佳治疗方案存在争议。目的是制定关于管理位于相对于危险关键器官处于中央或超中央位置的医学上无法手术的NSCLC的多学科专家共识指南。
由15名成员组成的多学科美国镭协会（ARS）胸部合理使用标准（AUC）专家小组制定了关于中央和超中央位置肺肿瘤的病例变体。对1946年1月1日至2023年12月31日的英文医学文献进行了全面回顾，以为共识指南提供信息。专家小组使用改良的德尔菲法评估变体和程序，中位数至少有三个评分点定义为达成一致/共识。然后该指南由ARS执行委员会批准，并按照既定的ARS程序发布以供公众评论。
胸部ARS AUC小组确定了90篇相关参考文献，并在所有变体上达成了共识。单独放疗被认为是合适的，额外的免疫治疗主要应在临床试验环境中考虑。8至18次分割的低分割放疗被认为适用于近端气管支气管树、上气管和食管附近的超中央病变。对于心脏、大血管、臂丛神经和脊柱附近的其他超中央病变，或对于非超中央但仍为中央的病变，五分割立体定向体部放射治疗也被认为是一种合适的选择。调强放射治疗被认为适用于所有变体，而三维适形放射治疗不合适。还考虑了其他降低危险关键器官过量照射风险的治疗计划技术。
ARS胸部AUC小组针对位于中央或超中央位置的I期NSCLC的各种表现制定了多学科共识指南。
