Badellino Serena, Cuccia Francesco, Galaverni Marco, Miele Marianna, Sepulcri Matteo, Zerella Maria Alessia, Spoto Ruggero, Alì Emanuele, Olmetto Emanuela, Boldrini Luca, Pontoriero Antonio, Borghetti Paolo
Radiation Oncology, Department of Oncology, University of Turin, 10125 Turin, Italy.
Radiation Oncology, ARNAS Civico Hospital-Palermo, 90145 Palermo, Italy.
J Clin Med. 2025 Jul 9;14(14):4871. doi: 10.3390/jcm14144871.
Stereotactic Body Radiotherapy (SBRT) has emerged as a pivotal treatment modality for early-stage non-small cell lung cancer (NSCLC), offering highly precise, high-dose radiation delivery. However, several clinical challenges remain, particularly in the treatment of central or ultracentral tumors, which are located near critical structures such as the heart, bronchi, and great vessels. The introduction of MRI-guided SBRT has significantly improved targeting precision, allowing for better assessment of tumor motion and adjacent organ structures. Additionally, SBRT has demonstrated efficacy in multifocal NSCLC, providing an effective option for patients with multiple primary tumors. Recent advances also highlight the role of SBRT in locally advanced NSCLC, where it is increasingly used as a complementary approach to concurrent chemotherapy or in cases where surgery is not feasible. Moreover, the combination of SBRT with immunotherapy has shown promising potential, enhancing tumor control and immunological responses. Furthermore, SBRTs application in SCLC is gaining momentum as a palliative and potentially curative option for selected patients. This narrative review explores these evolving clinical scenarios, the technical innovations supporting SBRT, and the integration of immunotherapy, providing an in-depth look at the new frontiers of SBRT in lung cancer treatment. Despite the challenges, the ongoing development of personalized approaches and technological advancements continues to push the boundaries of SBRTs clinical utility in lung cancer.
立体定向体部放疗（SBRT）已成为早期非小细胞肺癌（NSCLC）的关键治疗方式，可提供高精度、高剂量的放射治疗。然而，仍存在一些临床挑战，尤其是在治疗位于心脏、支气管和大血管等关键结构附近的中央型或超中央型肿瘤时。MRI引导的SBRT的引入显著提高了靶向精度，有助于更好地评估肿瘤运动和相邻器官结构。此外，SBRT在多灶性NSCLC中已显示出疗效，为患有多个原发性肿瘤的患者提供了一种有效的选择。最近的进展还突出了SBRT在局部晚期NSCLC中的作用，在这种情况下，它越来越多地被用作同步化疗的补充方法，或在手术不可行的情况下使用。此外，SBRT与免疫疗法的联合已显示出有前景的潜力，可增强肿瘤控制和免疫反应。此外，SBRT在小细胞肺癌（SCLC）中的应用作为一种姑息性和潜在治愈性选择，正逐渐受到更多关注，适用于特定患者。本叙述性综述探讨了这些不断演变的临床情况、支持SBRT的技术创新以及免疫疗法的整合，深入审视了SBRT在肺癌治疗中的新前沿。尽管存在挑战，但个性化方法和技术进步的不断发展继续推动SBRT在肺癌临床应用中的边界。
