Liu Xin, Wu Lei, Guo Tian, Huang Zhifeng, Chen Sen, Li ChenYang, Liu Qiufang, Wang Fenggang
Radiation Oncology Xi'an Medical University Xi'an Shaanxi China.
Department of Radiotherapy Hospital Shaanxi Provincial Cancer Hospital Xi'an Shaanxi China.
Precis Radiat Oncol. 2024 May 9;8(2):85-91. doi: 10.1002/pro6.1226. eCollection 2024 Jun.
Lung oligometastases represent an intermediate state of cancer dissemination between localized and widespread metastases. Stereotactic body radiation therapy (SBRT) has emerged as an effective treatment option, with an efficacy comparable to that of surgical resection. This review aimed to provide a comprehensive summary of the latest advancements and controversial issues regarding SBRT for lung oligometastases. It focuses on four crucial perspectives: efficacy of SBRT, optimal patient selection criteria, technological innovations, and synergistic effects of SBRT combined with systemic therapy. Relevant clinical trials investigating SBRT for lung oligometastases have been conducted, with median 1- and 5-year local control rates of 90% and 79%, respectively. The origin of the primary tumor, size and number of lesions, and biomarker profiles were highlighted as pivotal considerations in patient selection. The precise dose delivery was enhanced using robotic SBRT and optimized dose fractionation schemes. Evidence suggests that dose escalation above 100 Gy biologically effective dose may improve tumor control. Combined immunotherapy and SBRT have demonstrated synergistic effects in prolonging progression-free survival and overall survival. This review provides valuable insights into the precise treatment of oligometastatic lung diseases using SBRT. Further multicenter randomized trials are warranted to develop definitive patient selection criteria and optimize the integration with systemic therapies.
肺寡转移代表了癌症播散介于局限性转移和广泛性转移之间的一种中间状态。立体定向体部放疗（SBRT）已成为一种有效的治疗选择，其疗效与手术切除相当。本综述旨在全面总结SBRT治疗肺寡转移的最新进展和争议问题。它聚焦于四个关键方面：SBRT的疗效、最佳患者选择标准、技术创新以及SBRT联合全身治疗的协同效应。已经开展了针对肺寡转移的SBRT相关临床试验，1年和5年局部控制率的中位数分别为90%和79%。原发肿瘤的起源、病灶大小和数量以及生物标志物谱被强调为患者选择中的关键考虑因素。使用机器人SBRT和优化的剂量分割方案可提高剂量递送的精确性。有证据表明，生物有效剂量高于100 Gy时增加剂量可能会改善肿瘤控制。联合免疫治疗和SBRT已显示出在延长无进展生存期和总生存期方面的协同效应。本综述为使用SBRT精确治疗寡转移性肺部疾病提供了有价值的见解。有必要开展进一步的多中心随机试验，以制定明确的患者选择标准并优化与全身治疗的联合应用。
