局部晚期非小细胞肺癌放疗靶区勾画和计划设计指南

Guideline of target delineation and treatment planning for locally advanced non-small cell lung cancer

局部晚期非小细胞肺癌(NSCLC)占所有NSCLC患者总数的1/3,包括ⅢA期(可手术切除和不可手术切除)、ⅢB期、ⅢC期患者。放射治疗是局部晚期NSCLC的主要治疗之一。对于不可切除局部晚期NSCLC,以放疗为基础的综合治疗使得患者5年生存率达到42.9%。对于可切除ⅢA期患者,放疗的价值受到挑战,但多项回顾性研究和真实世界研究的部分高危患者依然可以从术后放疗中获益,提高生存率。整体上该期患者由于异质性较大,预后的个体差异较大。中国不同放射治疗中心的NSCLC诊疗常规、靶区勾画规范、计划设计规范仍有较大差异,医生、物理师的具体工作标准也可能存在差异。精准靶区勾画是放疗获益的重要前提,为了促进肺癌临床放疗的规范化、便于开展多中心临床研究,国家肿瘤质控中心参考国内外已发布的相关标准制定此精准放疗技术下局部晚期NSCLC根治性同步放化疗和术后放疗路径、适应证、靶区勾画和计划评价指南,旨在为国内各放疗单位提供参考。

Locally advanced non-small cell lung cancer(NSCLC)represent approximately one third of patients diagnosed with NSCLC,including stage IIIA(resectable and unresectable),and stage IIIB and IIIC patients.Radiotherapy(RT)plays a major role in the curative and adjuvant treatment of locally advanced NSCLC.RT-based comprehensive therapy achieves a 5-year overall survival of 42.9%for unresectable locally advanced NSCLC.For resectable stage IIIA patients,the value of postoperative RT is challenged.However,plenty of retrospective and real-world studies showed postoperative RT could increase overall survival for patients with high risk of relapse.Given the disease inherent heterogeneity,patients have significantly different outcomes.Moreover,significant differences in conventional diagnosis and treatment of NSCLC,target delineation and RT planning are widely observed across domestic RT institutions,and discrepancies may be found in specific work standards among doctors and physicists.Precise target delineation is an important prerequisite for RT benefits.The National Cancer Quality Control Center formulates the guideline for clinical routine practice,indications,target delineation and treatment plan design in definitive(chemo)RT and adjuvant RT for locally advanced NSCLC by referring to relevant standards at home and abroad,aiming to promote the implementation of standardized RT for NSCLC,facilitate multi-center clinical trials and provide reference for RT institutions in China.