Background/Objectives: Stereotactic body radiation therapy (SBRT) has demonstrated high local control rates for inoperable early-stage lung cancers. However, 5–15% of patients experience local relapse within the irradiated volume after treatment, with limited curative salvage options. The aim of this review is to clarify the modalities and outcomes after a second course of SBRT in patients with local relapse after a previous lung SBRT. Methods: An exhaustive literature review was conducted to identify, analyse and summarise the results of 21 main studies. Results: Local repeat lung SBRT after a first course of SBRT showed a favourable local control at 1 and 2 years, ranging from 70 to 90% and 45 to 80%, respectively. Good overall survival rates were also observed at 1 and 2 years reaching up to 95% and 85%, respectively. Toxicity was rare but could be severe, with cases of Grade 4 and 5 toxicities (≈5%). An important dose relationship was observed between re-irradiation dose levels and local control, highlighting the importance of precise dosing. The cumulative doses impacting organs at risk were similarly associated with increased radiation-induced toxicity. Central lung lesions presented a higher risk for severe side effects compared to peripheral ones. Conclusions: In conclusion, repeat lung SBRT after a first course of SBRT represents a feasible treatment option in cases of local recurrence. In order to limit severe toxicity, patients must be carefully selected, and particular attention should be given to cumulative doses to organs at risk, as well as tumour location. Thus, further investigations are still needed to refine the optimal parameters for SBRT lung re-irradiation.
背景/目的：立体定向放射治疗（SBRT）对无法手术的早期肺癌显示出较高的局部控制率。然而，5%–15%的患者在治疗后照射区域内出现局部复发，且有效的挽救治疗方案有限。本综述旨在阐明首次肺部SBRT后局部复发患者接受第二疗程SBRT的治疗模式及临床结局。方法：通过系统性文献回顾，对21项主要研究的结果进行识别、分析和总结。结果：首次SBRT后实施重复肺部SBRT显示出良好的局部控制率，1年和2年局部控制率分别为70%–90%和45%–80%。同时观察到良好的总生存率，1年和2年生存率最高分别达95%和85%。治疗毒性发生率较低但可能较为严重，4级和5级毒性发生率约为5%。再照射剂量水平与局部控制率存在显著剂量相关性，凸显了精确剂量调控的重要性。危及器官的累积剂量同样与放射性毒性增加相关。与周围型病灶相比，中央型肺部病灶引发严重副作用的风险更高。结论：综上所述，对于局部复发病例，首次SBRT后实施重复肺部SBRT是一种可行的治疗选择。为限制严重毒性反应，需严格筛选患者，并特别关注危及器官的累积剂量及肿瘤位置。因此，仍需进一步研究以优化肺部SBRT再照射的最佳参数。
肿瘤(癌症)患者之家