非小细胞肺癌体部寡转移的立体定向放射治疗

Treatment of Oligometastasis of Non-small Cell Lung Cancer by Stereotactic Body Radiation Therapy

非小细胞肺癌(Non-small cell lung cancer, NSCLC)寡转移是NSCLC转移过程中的一种中间状态,是肿瘤生物侵袭过程中较温和的一个阶段,它介于原发灶与远处广泛转移之间,转移瘤数目≦5个,受累器官≦2个,此时肿瘤细胞尚不具备全身播散的倾向。晚期恶性肿瘤患者很大部分处于寡转移状态,而约30%的非小细胞肺癌(NSCLC)患者死于寡转移,目前对于寡转移的治疗以局部治疗为主(包括手术、放疗以及射频消融)。治疗隐匿性转移灶、寡转移灶及全身化学治疗结束后清除残留局部病灶成为治疗寡转移的关键,越来越得到专家共识。在无法手术或者拒绝手术的患者中,局部放放射治疗凸显巨大优势,尤其是体部立体定向放射治疗(Stereotactic Body Radiation Therapy, SBRT),大量临床研究结果显示体部立体定向放射治疗NSCLC寡转移是安全有效的,并能提高转移灶的局部控制率。本文旨在对SBRT治疗非小细胞肺癌寡转移的临床进展做一综述。

Oligometastasis of Non-small cell lung cancer(NSCLC)is a milder stage of tumor biological invasiveness,and a state model in the process of tumor metastasis,a intermediate state between local and widespread disease.The number of metastases is limited less than or equal to five in no more than two different organs,and does not have the genetic tendency of systemic spread.Most patients with advanced malignant tumors are in oligometastases state,and about 30%of NSCLC patients die of oligometastases.It has been suggested that local therapies play an important role in this setting(including surgery,radiotherapy and radiofrequency).Prevention of distant metastasis,treatment of occult metastases,oligometastases and elimination of residual disease after the completion of systemic therapy have become the key to the treatment of oligometastases.In patients with inoperable or refusal of surgery,radiotherapy has a great benefit in this setting,especially stereotactic body radiation therapy(SBRT).Abundant clinical researches have demonstrated that SBRT is effective and safe for the treatment of oligometastasis of NSCLC,with high local control rates of treated metastasis.This review aims to outline the treatment of oligometastasis of Non-small cell lung cancer by stereotactic body radiation therapy.