Salvestrini Viola, Lastrucci Andrea, Banini Marco, Loi Mauro, Carnevale Maria Grazia, Olmetto Emanuela, Garlatti Pietro, Simontacchi Gabriele, Francolini Giulio, Bonomo Pierluigi, Wandael Yannick, Desideri Isacco, Ricci Renzo, Giansanti Daniele, Scotti Vieri, Livi Lorenzo
Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy.
Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy.
Cancers (Basel). 2024 Dec 11;16(24):4135. doi: 10.3390/cancers16244135.
Stereotactic body radiotherapy has been established as a viable treatment option for inoperable early-stage non-small cell lung cancer or secondary lesions mainly in oligoprogressive/oligometastatic scenarios. Treating lesions in the so-called "no flight zone" has always been challenging and conflicting data never cleared how to safely treat these lesions. This is truer considering ultra-central lesions, i.e., directly abutting or whose PTV is overlapping critical mediastinal organs. While historical retrospective data are abundant but mostly heterogenous in terms of the definition of ultra-central lesions, dosing regimens and outcomes, prospective data remain scarce, even though recently published studies have given new encouraging results for such delicate treatment scenarios. For this reason, we aimed to review and summarize current knowledge on stereotactic radiation treatment for ultra-central thoracic lesions, highlighting the most recent advances and the messages that can be taken from them. Lastly, we propose a workflow of the necessary steps to identify and treat such patients, therefore helping in elucidating the advantages and caveats of such treatment options.
立体定向体部放疗已被确立为不可手术的早期非小细胞肺癌或主要在寡进展/寡转移情况下的继发性病变的一种可行治疗选择。在所谓的“禁区”治疗病变一直具有挑战性，相互矛盾的数据从未明确如何安全地治疗这些病变。考虑到超中央病变，即直接毗邻或其计划靶体积与关键纵隔器官重叠的病变，情况更是如此。虽然历史回顾性数据丰富，但在超中央病变的定义、给药方案和结果方面大多存在异质性，前瞻性数据仍然稀缺，尽管最近发表的研究为这种精细的治疗情况给出了新的令人鼓舞的结果。出于这个原因，我们旨在回顾和总结当前关于超中央胸部病变立体定向放射治疗的知识，突出最新进展以及从中可以获得的信息。最后，我们提出了识别和治疗此类患者的必要步骤的工作流程，从而有助于阐明此类治疗选择的优势和注意事项。
