Stergioula Anastasia, Kormas Theodoros, Kokkali Stefania, Kyriazoglou Anastasios, Pantelis Evaggelos
Department of Radiotherapy, Iatropolis Clinic, Athens, GRC.
Department of Orthopedic Surgery, Agios Savvas Anticancer Hospital, Athens, GRC.
Cureus. 2025 Apr 11;17(4):e82084. doi: 10.7759/cureus.82084. eCollection 2025 Apr.
The lungs represent the most common sites of distant metastases in soft tissue sarcoma (STS) patients. The relative radioresistance of STS renders them ideal targets for stereotactic radiotherapy (SRT). In this study, the treatment of a complex STS lung metastases case involving complete main bronchus occlusion and lung collapse using an image-guided, personalized ultrafractionated stereotactic adaptive radiotherapy (PULSAR) approach is reported. A biologically effective dose (BED) of 102 Gy was delivered in two stages separated by 21 days using the CyberKnife platform (Accuray Inc., Sunnyvale, CA, USA) and the Synchrony Lung Optimized (Synchrony-LOT) motion management system (Accuray Inc.). Each treatment stage was based on real-time imaging data, allowing for the adaption of the treatment plan to the tumor's size and shape. Prior to the second stage, significant tumor regression was observed, leading to lung re-expansion and restoration of pulmonary function. This expansion enabled the visualization and treatment of a second peripheral lesion, which received a BED of 106 Gy in a single session. The applied treatment protocol resulted in excellent local control and minimal toxicity. The combination of the PULSAR approach and real-time imaging techniques hold significant promise for treating complex cases and marks a shift toward more adaptive and personalized radiation oncology.
肺是软组织肉瘤（STS）患者远处转移最常见的部位。STS相对的放射抗性使其成为立体定向放射治疗（SRT）的理想靶点。在本研究中，报告了一例复杂的STS肺转移病例的治疗情况，该病例采用图像引导的个体化超分割立体定向自适应放射治疗（PULSAR）方法，涉及主支气管完全闭塞和肺萎陷。使用射波刀平台（美国加利福尼亚州森尼韦尔市Accuray公司）和同步肺部优化（Synchrony-LOT）运动管理系统（Accuray公司），在间隔21天的两个阶段给予102 Gy的生物等效剂量（BED）。每个治疗阶段均基于实时成像数据，从而使治疗计划能够根据肿瘤的大小和形状进行调整。在第二阶段之前，观察到肿瘤显著消退，导致肺复张和肺功能恢复。这种扩张使得能够可视化并治疗第二个周边病变，该病变在单次治疗中接受了106 Gy的BED。所应用的治疗方案实现了出色的局部控制且毒性极小。PULSAR方法与实时成像技术的结合在治疗复杂病例方面具有巨大潜力，并标志着向更具适应性和个性化的放射肿瘤学的转变。
