To SABR or Not to SABR? Indications and Contraindications for Stereotactic Ablative Radiotherapy in the Treatment of Early-Stage, Oligometastatic, or Oligoprogressive Non-Small Cell Lung Cancer
To SABR or Not to SABR? Indications and Contraindications for Stereotactic Ablative Radiotherapy in the Treatment of Early-Stage, Oligometastatic, or Oligoprogressive Non-Small Cell Lung Cancer
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DOI：
10.1016/j.semradonc.2014.11.005
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发表时间：
2015-04-01
影响因子：
3.5
通讯作者：
Loo, Billy W., Jr.
中科院分区：
文献类型：
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作者：
Shultz, David Benjamin;Diehn, Maximilian;Loo, Billy W., Jr.
立体定向消融放射治疗(SABR)是治疗早期非小细胞肺癌的一种高效方法。尽管无法从随机试验中进行直接比较，但SABR和外科手术的原发肿瘤控制率和远处转移率是相似的。与手术相比，SABR后的总体生存率较低，这在很大程度上反映了SABR的一个主要选择标准是由于心肺功能下降和其他导致非小细胞肺癌患者生存率下降的并发症而导致的内科不可操作性。在倾向匹配的队列中，SABR和手术之间的生存结果更加相似。SABR的新的潜在适应症包括治疗可手术的患者；SABR已成为转移切除的替代选择的少转移肺癌；以及寡进展性肺癌，一个吸引人的概念，特别是随着改进的个性化系统治疗的出现，目前正在这些环境中进行前瞻性试验。虽然现代系列的毒性很低，但SABR显然能够产生致命的并发症，近年来，人们开始了解危险因素和减轻这些并发症的方法。因此，恰当的患者选择是一个重要的、不断发展的和有争议的话题。(C)2015 Elsevier Inc.保留所有权利。
Stereotactic ablative radiotherapy (SABR) is a highly effective treatment for early-stage non small cell lung cancer. Although direct comparisons from randomized trials are not available, rates of both primary tumor control and distant metastasis are similar between SABR and surgery. Overall survival is lower after SABR compared with surgery, largely reflecting that a primary selection criterion for SABR has been medical inoperability because of decreased cardiopulmonary function and other comorbidities that lead to decreased survival independent of non small cell lung cancer. Survival outcomes between SABR and surgery are much more similar in propensity-matched cohorts. Newer potential indications for SABR include treatment of operable patients; of oligometastatic lung cancer, in which SABR has emerged as an alternative to metastasectomy; and of oligoprogressive lung cancer, an attractive concept especially as improved personalized systemic therapies emerge, and prospective trials are currently being conducted in these settings. Although toxicity in modem series is low, SABR is clearly capable of producing fatal complications, and understanding the risk factors and approaches for mitigating them has been emerging in recent years. Thus, appropriate patient selection is a vital, evolving, and controversial topic. (C) 2015 Elsevier Inc. All rights reserved.