早期非小细胞肺癌立体定向放射治疗指南

摘要/Abstract

摘要：

中国医师协会放射肿瘤治疗医师分会. 早期非小细胞肺癌立体定向放射治疗指南[J]. 国际肿瘤学杂志, 2022, 49(1): 1-11.

图/表17

表1

早期NSCLC患者SBRT治疗常用剂量分割建议"

分型	适应证	剂量及分次	参考来源
周围型	小病灶(<2 cm),GTV距胸壁>1 cm	34 Gy/1 F	RTOG 0915
	PTV不紧贴胸壁时	5460 Gy/3 F^a	RTOG 0618和RTOG 0236
		6066 Gy/3 F	参考文献[ 12 , 13 ]
		45 Gy/3 F	参考文献[ 14 ]
	PTV紧邻或与胸壁重叠时	4860 Gy/45 F^b	RTOG 0915/参考文献[ 13 ]
中央型	PTV在中央或毗邻中央区内,但在超中央区外	5060 Gy/5 F	RTOG 0813
		50 Gy/4 F或70 Gy/10 F	参考文献[ 15 ]
		60 Gy/8 F	参考文献[ 13 ]
	PTV超中央型的区域内	5060 Gy/810 F^c	参考文献[ 16 , 17 , 18 , 19 ]

表1

表2

早期NSCLC患者SBRT治疗中光子束照射处方剂量在异质性组织的适形性评价"

PTV(cm³)	处方剂量体积与 PTV体积比			50%处方剂量体积与 PTV体积比,R_50%			PTV外2 cm处最大剂量, D_{2 cm}(Gy)			肺20 Gy所占体积百分比, V_{20 Gy}(%)
	偏差			偏差			偏差			偏差
		无		可接受			无	可接受			无	可接受	无	可接受
1.8	<1.2	<1.5	<5.9		<7.5	<50.0		<57.0	<10		<15
3.8	<1.2	<1.5	<5.5		<6.5	<50.0		<57.0	<10		<15
7.4	<1.2	<1.5	<5.1		<6.0	<50.0		<58.0	<10		<15
13.2	<1.2	<1.5	<4.7		<5.8	<50.0		<58.0	<10		<15
22.0	<1.2	<1.5	<4.5		<5.5	<54.0		<63.0	<10		<15
34.0	<1.2	<1.5	<4.3		<5.3	<58.0		<68.0	<10		<15
50.0	<1.2	<1.5	<4.0		<5.0	<62.0		<77.0	<10		<15
70.0	<1.2	<1.5	<3.5		<4.8	<66.0		<86.0	<10		<15
95.0	<1.2	<1.5	<3.3		<4.4	<70.0		<89.0	<10		<15
126.0	<1.2	<1.5	<3.1		<4.0	<73.0		<91.0	<10		<15
163.0	<1.2	<1.5	<2.9		<3.7	<77.0		<94.0	<10		<15

表2

图1

图2

图3

图4

图5

图6

图7

图8

表3

NCCN指南及RTOG SBRT临床试验关于肺癌OAR最大剂量限制标准"

OAR	1 F	3 F	4 F	5 F
脊髓	14 Gy	18 Gy(6 Gy/F)	26 Gy(6.5 Gy/F)	30 Gy(6 Gy/F)
食管	15.4 Gy	27 Gy(9 Gy/F)	30 Gy(7.5 Gy/F)	105%PTV处方剂量
臂丛神经	17.5 Gy	24 Gy(8 Gy/F)	27.2 Gy(6.8 Gy/F)	32 Gy(6.4 Gy/F)
心脏/心包	22 Gy	30 Gy(10 Gy/F)	34 Gy(8.5 Gy/F)	105%PTV处方剂量
大血管	37 Gy	NS	49 Gy(12.25 Gy/F)	105%PTV处方剂量
气管及近端支气管	20.2 Gy	30 Gy(10 Gy/F)	34.8 Gy(8.7 Gy/F)	105%PTV处方剂量
肺	V₇<1 500 cm³	V_10.5<1 500 cm³	V_11.6<1 500 cm³	V_12.5<1 500 cm³
	V_7.4<1 000 cm³	V_11.4<1 000 cm³	V_12.4<1 000 cm³	V_13.5<1 000 cm³
肋骨	30 Gy	30 Gy(10 Gy/F)	40 Gy(10 Gy/F)	NS
皮肤	26 Gy	24 Gy(8 Gy/F)	36 Gy(9 Gy/F)	32 Gy(6.4 Gy/F)
胃	12.4 Gy	NS	27.2 Gy(6.8 Gy/F)	NS
肝脏		17.1 Gy(5.7 Gy/Fx)	19.2 Gy(4.8 Gy/Fx)	21 Gy(4.2 Gy/Fx)

表3

图9

图10

图11

图12

图13

图14

参考文献32

[1]	Postmus PE, Kerr KM, Oudkerk M, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2017, 28(suppl_4): iv1-iv21. DOI: 10.1093/annonc/mdx222. doi:10.1093/annonc/mdx222
[2]	Ramon RP, Hisao A, William DT, et al. Lung//Amin MB, Edge SB, Greene FL, eds. AJCC Cancer Staging Manual. Eighth Edition[M]. Chicago, USA: Springer, 2017: 431-456. DOl: 10.1007/978-3-319-40618-3_36. doi:10.1007/978-3-319-40618-3_36
[3]	Howlader N, Noone AM, Krapcho M, et al. SEER cancer statistics review, 1975-2016[EB/OL]. [2020-04-09]. https://seer.cancer.gov/csr/1975_2016/.
[4]	Palma D, Visser O, Lagerwaard FJ, et al. Impact of introducing ste-reotactic lung radiotherapy for elderly patients with stage Ⅰ non-small-cell lung cancer: a population-based time-trend analysis[J]. J Clin Oncol, 2010, 28(35):5153-5159. DOI: 10.1200/jco.2010.30.0731. doi:10.1200/jco.2010.30.0731
[5]	Timmerman RD, Hu C, Michalski J, et al. Long-term results of RTOG 0236: a phase Ⅱ trial of stereotactic body radiation therapy (SBRT) in the treatment of patients with medically inoperable stage Ⅰ non-small cell lung cancer[J]. Int J Radiat Oncol Biol Phys, 2014, 90(suppl_1):S30. DOI: 10.1016/j.ijrobp.2014.05.135. doi:10.1016/j.ijrobp.2014.05.135
[6]	Murray P, Franks K, Hanna GG. A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer[J]. Br J Radiol, 2017, 90(1071):20160732. DOI: 10.1259/bjr.20160732. doi:10.1259/bjr.20160732
[7]	Modh A, Rimner A, Williams E, et al. Local control and toxicity in a large cohort of central lung tumors treated with stereotactic body radiation therapy[J]. Int J Radiat Oncol Biol Phys, 2014, 90(5):1168-1176. DOI: 10.1016/j.ijrobp.2014.08.008. doi:10.1016/j.ijrobp.2014.08.008
[8]	Mangona VS, Aneese AM, Marina O, et al. Toxicity after central versus peripheral lung stereotactic body radiation therapy: a propensity score matched-pair analysis[J]. Int J Radiat Oncol Biol Phys, 2015, 91(1):124-132. DOI: 10.1016/j.ijrobp.2014.08.345. doi:10.1016/j.ijrobp.2014.08.345
[9]	Chang JY, Mehran RJ, Feng L, et al. Stereotactic ablative radiothe-rapy for operable stage Ⅰ non-small-cell lung cancer (revised STARS): long-term results of a single-arm, prospective trial with prespecified comparison to surgery[J]. Lancet Oncol, 2021, 22(10):1448-1457. DOI: 10.1016/s1470-2045(21)00401-0. doi:10.1016/s1470-2045(21)00401-0
[10]	Steffen IG, Wust P, Rühl R, et al. Value of combined PET/CT for radiation planning in CT-guided percutaneous interstitial high-dose-rate single-fraction brachytherapy for colorectal liver metastases[J]. Int J Radiat Oncol Biol Phys, 2010, 77(4):1178-1185. DOI: 10.1016/j.ijrobp.2009.06.047. doi:10.1016/j.ijrobp.2009.06.047
[11]	中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放射治疗学专业委员会, 中国医师协会放射治疗医师分会. 早期非小细胞肺癌立体定向放疗中国专家共识(2019版)[J]. 中华肿瘤杂志, 2020, 42(7):522-530. DOI: 10.3760/cma.j.cn112152-20200116-00039. doi:10.3760/cma.j.cn112152-20200116-00039
[12]	Timmerman R, McGarry R, Yiannoutsos C, et al. Excessive toxicity when treating central tumors in a phase Ⅱ study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer[J]. J Clin Oncol, 2006, 24(30):4833-4839. DOI: 10.1200/JCO.2006.07.5937. doi:10.1200/JCO.2006.07.5937pmid:17050868
[13]	Lagerwaard FJ, Haasbeek CJ, Smit EF, et al. Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage Ⅰ non-small-cell lung cancer[J]. Int J Radiat Oncol Biol Phys, 2008, 70(3):685-692. DOI: 10.1016/j.ijrobp.2007.10.053. doi:10.1016/j.ijrobp.2007.10.053
[14]	Baumann P, Nyman J, Hoyer M, et al. Outcome in a prospective phase Ⅱ trial of medically inoperable stage Ⅰ non-small-cell lung cancer patients treated with stereotactic body radiotherapy[J]. J Clin Oncol, 2009, 27(20):3290-3296. DOI: 10.1200/JCO.2008.21.5681. doi:10.1200/JCO.2008.21.5681pmid:19414667
[15]	Chang JY, Li QQ, Xu QY, et al. Stereotactic ablative radiation therapy for centrally located early stage or isolated parenchymal recurrences of non-small cell lung cancer: how to fly in a "no fly zone"[J]. Int J Radiat Oncol Biol Phys, 2014, 88(5):1120-1128. DOI: 10.1016/j.ijrobp.2014.01.022. doi:10.1016/j.ijrobp.2014.01.022
[16]	Zhao Y, Khawandanh E, Thomas S, et al. Outcomes of stereotactic body radiotherapy 60 Gy in 8 fractions when prioritizing organs at risk for central and ultracentral lung tumors[J]. Radiat Oncol, 2020, 15(1):61. DOI: 10.1186/s13014-020-01491-w. doi:10.1186/s13014-020-01491-w
[17]	Raman S, Yau V, Pineda S, et al. Ultracentral tumors treated with stereotactic body radiotherapy: single-institution experience[J]. Clin Lung Cancer, 2018, 19(5):e803-e810. DOI: 10.1016/j.cllc.2018.06.001. doi:10.1016/j.cllc.2018.06.001
[18]	Meng MB, Wang HH, Zaorsky NG, et al. Risk-adapted stereotactic body radiation therapy for central and ultra-central early-stage inoperable non-small cell lung cancer[J]. Cancer Sci, 2019, 110(11):3553-3564. DOI: 10.1111/cas.14185. doi:10.1111/cas.14185
[19]	Tekatli H, Haasbeek N, Dahele M, et al. Outcomes of hypofractionated high-dose radiotherapy in poor-risk patients with "ultracentral" non-small cell lung cancer[J]. J Thorac Oncol, 2016, 11(7):1081-1089. DOI: 10.1016/j.jtho.2016.03.008. doi:10.1016/j.jtho.2016.03.008pmid:27013408
[20]	Lindberg K, Bergström P, Brustugun OT, et al. OA24.05 the Nordic HILUS-trial-first report of a phase Ⅱ trial of SBRT of centrally located lung tumors[J]. J Thorac Oncol, 2017, 12(1):S340. DOI: 10.1016/j.jtho.2016.11.369. doi:10.1016/j.jtho.2016.11.369
[21]	Chaudhuri AA, Tang C, Binkley MS, et al. Stereotactic ablative radiotherapy (SABR) for treatment of central and ultra-central lung tumors[J]. Lung Cancer, 2015, 89(1):50-56. DOI: 10.1016/j.lungcan.2015.04.014. doi:10.1016/j.lungcan.2015.04.014pmid:25997421
[22]	Lenglet A, Campeau MP, Mathieu D, et al. Risk-adapted stereotactic ablative radiotherapy for central and ultra-central lung tumours[J]. Radiother Oncol, 2019, 134:178-184. DOI: 10.1016/j.radonc.2019.01.035. doi:S0167-8140(19)30063-5pmid:31005213
[23]	Tambe NS, Fryer A, Marsden JE, et al. Determination of clinically appropriate flattening filter free (FFF) energy for treating lung SABR using treatment plans and delivery measurements[J]. Biomed Phys Eng Express, 2016, 2(6):065016. DOI: 10.1088/2057-1976/2/6/065016. doi:10.1088/2057-1976/2/6/065016
[24]	Li J, Galvin J, Harrison A, et al. Dosimetric verification using monte carlo calculations for tissue heterogeneity-corrected conformal treatment plans following RTOG 0813 dosimetric criteria for lung cancer stereotactic body radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2012, 84(2):508-513. DOI: 10.1016/j.ijrobp.2011.12.005. doi:10.1016/j.ijrobp.2011.12.005
[25]	Hurkmans CW, Cuijpers JP, Lagerwaard FJ, et al. Recommen-dations for implementing stereotactic radiotherapy in peripheral stage ⅠA non-small cell lung cancer: report from the Quality Assurance Working Party of the randomised phase Ⅲ ROSEL study[J]. Radiat Oncol, 2009, 4:1. DOI: 10.1186/1748-717X-4-1. doi:10.1186/1748-717X-4-1pmid:19138400
[26]	Ueki N, Matsuo Y, Togashi Y, et al. Impact of pretreatment interstitial lung disease on radiation pneumonitis and survival after ste-reotactic body radiation therapy for lung cancer[J]. J Thorac Oncol, 2015, 10(1):116-125. DOI: 10.1097/JTO.0000000000000359. doi:10.1097/JTO.0000000000000359
[27]	Bahig H, Filion E, Vu T, et al. Severe radiation pneumonitis after lung stereotactic ablative radiation therapy in patients with interstitial lung disease[J]. Pract Radiat Oncol, 2016, 6(5):367-374. DOI: 10.1016/j.prro.2016.01.009. doi:10.1016/j.prro.2016.01.009
[28]	Forquer JA, Fakiris AJ, Timmerman RD, et al. Brachial plexopathy from stereotactic body radiotherapy in early-stage NSCLC: dose-limiting toxicity in apical tumor sites[J]. Radiother Oncol, 2009, 93(3):408-413. DOI: 10.1016/j.radonc.2009.04.018. doi:10.1016/j.radonc.2009.04.018
[29]	Lindberg K, Grozman V, Lindberg S, et al. Radiation-induced brachial plexus toxicity after SBRT of apically located lung lesions[J]. Acta Oncol, 2019, 58(8):1178-1186. DOI: 10.1080/0284186X.2019.1601255. doi:10.1080/0284186X.2019.1601255pmid:31066326
[30]	Song SY, Choi W, Shin SS, et al. Fractionated stereotactic body radiation therapy for medically inoperable stage Ⅰ lung cancer adjacent to central large bronchus[J]. Lung Cancer, 2009, 66(1):89-93. DOI: 10.1016/j.lungcan.2008.12.016. doi:10.1016/j.lungcan.2008.12.016
[31]	Abelson JA, Murphy JD, Loo BW, et al. Esophageal tolerance to high-dose stereotactic ablative radiotherapy[J]. Dis Esophagus, 2012, 25(7):623-629. DOI: 10.1111/j.1442-2050.2011. 01295.x. doi:10.1111/j.1442-2050.2011.01295.xpmid:22168251
[32]	Evans JD, Gomez DR, Amini A, et al. Aortic dose constraints when reirradiating thoracic tumors[J]. Radiother Oncol, 2013, 106(3):327-332. DOI: 10.1016/j.radonc.2013.02.002. doi:10.1016/j.radonc.2013.02.002

早期非小细胞肺癌立体定向放射治疗指南

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