Alfaifi Salem, Louie Alexander V, Siva Shankar, Guckenberger Matthias, Videtic Gregory M M, Higgins Kristin A, Alshafa Faiz, AlGhamdi Hamza, Gillespie Erin F, Stephans Kevin, Mula-Hussain Layth, Harrow Stephen, Palma David A
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio; Department of Radiation Oncology, King Faisal Medical City, Abha, Saudi Arabia.
Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Int J Radiat Oncol Biol Phys. 2025 Apr 29. doi: 10.1016/j.ijrobp.2025.04.022.
To generate an understanding of the similarities and variations in international practice patterns for SABR in early-stage non-small cell lung cancer.
An online survey was conducted from October to December 2023, addressing general clinical and technical considerations for lung SABR, and for 5 specific anatomic non-small cell lung cancer locations (peripheral, abutting chest wall, near brachial plexus, central, and ultracentral). Invitations to participate were extended through email and were distributed on social media.
The survey was completed by 255 radiation oncologists, each representing a single institution across 51 countries. Respondents reported treating a median of 20 cases annually. A total of 38% of participants reported using single-fraction SABR, and 54% applied an upper limit on the maximum dose (Dmax). Among those who applied a Dmax limit, 58% reported a Dmax threshold at ≥130% of the prescription, though this limit varied by region and national economy status. Respondents from low- and middle-income countries were less likely to set a Dmax limit at ≥130% (30% vs 66%, P < .01) and less likely to use single-fraction SABR (14% vs 44%, P < .01). Higher annual SABR patient volumes were associated with higher Dmax adoption (г = 0.23, P < .01). Across the 5 clinical scenarios presented; 57 distinct dose regimens were recommended. The most common regimen in each scenario was: 54 Gy in 3 fractions for peripheral tumors, 50 Gy in 5 fractions for apical, central, and abutment of chest wall, and 60 Gy in 8 fractions for ultracentral tumors. Approximately two-thirds of practices recommend a biologically effective dose (BED) <100 Gy for ≥1 anatomic sites.
The findings reveal considerable variation in global SABR practice. These differences highlight the need for further data to guide prescription practices, and an international experts' consensus may be beneficial to standardize practice.
了解早期非小细胞肺癌立体定向消融放疗（SABR）在国际上的实践模式的异同。
2023年10月至12月进行了一项在线调查，涉及肺部SABR的一般临床和技术考量，以及5个特定解剖部位的非小细胞肺癌（外周型、紧贴胸壁型、靠近臂丛神经型、中央型和超中央型）。通过电子邮件发出参与邀请，并在社交媒体上进行分发。
255名放射肿瘤学家完成了调查，他们各自代表51个国家的单一机构。受访者报告称每年治疗的病例数中位数为20例。共有38%的参与者报告使用单次分割SABR，54%的参与者对最大剂量（Dmax）设定了上限。在设定Dmax上限的参与者中，58%报告Dmax阈值为处方剂量的≥130%，不过这一限制因地区和国民经济状况而异。低收入和中等收入国家的受访者在≥130%时设定Dmax上限的可能性较小（30%对66%，P<.01），使用单次分割SABR的可能性也较小（14%对44%，P<.01）。每年SABR患者治疗量越高与采用更高的Dmax相关（г=0.23，P<.01）。在呈现的5种临床情况中，共推荐了57种不同的剂量方案。每种情况中最常见的方案是：外周肿瘤为3次分割54 Gy，肺尖、中央型和胸壁紧贴型为5次分割50 Gy，超中央型肿瘤为8次分割60 Gy。约三分之二的实践对≥1个解剖部位推荐生物等效剂量（BED）<100 Gy。
研究结果揭示了全球SABR实践存在相当大的差异。这些差异凸显了需要进一步的数据来指导处方实践，国际专家共识可能有助于规范实践。
