Stereotactic body radiotherapy has been established as a viable treatment option for inoperable early-stage non-small cell lung cancer or secondary lesions mainly in oligoprogressive/oligometastatic scenarios. Treating lesions in the so-called “no flight zone” has always been challenging and conflicting data never cleared how to safely treat these lesions. This is truer considering ultra-central lesions, i.e., directly abutting or whose PTV is overlapping critical mediastinal organs. While historical retrospective data are abundant but mostly heterogenous in terms of the definition of ultra-central lesions, dosing regimens and outcomes, prospective data remain scarce, even though recently published studies have given new encouraging results for such delicate treatment scenarios. For this reason, we aimed to review and summarize current knowledge on stereotactic radiation treatment for ultra-central thoracic lesions, highlighting the most recent advances and the messages that can be taken from them. Lastly, we propose a workflow of the necessary steps to identify and treat such patients, therefore helping in elucidating the advantages and caveats of such treatment options.
立体定向体部放疗已被确立为不可手术的早期非小细胞肺癌或主要处于寡进展/寡转移情况下的继发性病灶的可行治疗选择。治疗所谓“禁飞区”内的病灶一直具有挑战性，且相互矛盾的数据从未明确如何安全治疗这些病灶。考虑到超中央型病灶——即直接毗邻或计划靶区与关键纵隔器官重叠的情况——这一点尤为突出。尽管历史回顾性数据丰富，但在超中央型病灶的定义、剂量方案和结果方面大多存在异质性，而前瞻性数据仍然稀缺，尽管最近发表的研究为这种精细的治疗场景提供了新的令人鼓舞的结果。因此，我们旨在回顾和总结当前关于超中央型胸部病灶立体定向放疗的知识，强调最新进展及其启示。最后，我们提出了识别和治疗此类患者所需步骤的工作流程，从而有助于阐明此类治疗方案的优点和注意事项。
肿瘤(癌症)患者之家