Prise en charge des stades précoces des cancers bronchiques non à petites cellules : radiothérapie en conditions stéréotaxiques

Q4 Medicine Revue des Maladies Respiratoires Actualites Pub Date : 2024-10-01 DOI:10.1016/S1877-1203(24)00082-X

F. Le Tinier , C. Durdux , D. Lerouge , L. Kaoutar

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Abstract

Surgery remains the reference treatment for primary non-small cell lung cancer (NSCLC) T1-T2 N0. However, 20-30 % of patients present a surgical contraindication. For these patients who cannot be operated on, stereotactic radiotherapy (SBRT) has been validated as the alternative of choice by learned medical societies. These two treatments are aimed at different populations, with a recognized role for these tumours local control. Radiotherapy remains less risky for fragile patients, but maybe at the cost of a higher risk of lymph node recurrence. The role of systemic treatment in association with stereotactic radiotherapy remains to be determined, particularly for non-operable T3NO tumours.

Several complex clinical situations can be identified depending on the location and size of the tumour, the patient’s history of irradiation and co-morbidities. The treatment of central tumours, re-irradiation, which is becoming increasingly frequent with advances in systemic treatments, and treatment of patients with pulmonary fibrosis represent a real technical challenge, requiring a specialized multi-disciplinary assessment to evaluate the benefit-risk ratio.

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早期非小细胞肺癌的治疗：立体定向条件下的放射治疗

手术仍然是治疗原发性非小细胞肺癌（NSCLC）T1-T2 N0 的首选方法。然而，20%-30%的患者有手术禁忌症。对于这些无法接受手术的患者，立体定向放射治疗（SBRT）已被医学学会确认为首选治疗方法。这两种治疗方法针对不同的人群，对这些肿瘤的局部控制具有公认的作用。对于脆弱的患者来说，放疗的风险仍然较低，但代价可能是淋巴结复发的风险较高。根据肿瘤的位置和大小、患者的照射史和并发症，可以确定几种复杂的临床情况。中心性肿瘤的治疗、随着全身治疗方法的进步而日益频繁的再次照射以及肺纤维化患者的治疗是一项真正的技术挑战，需要进行专门的多学科评估，以评估收益风险比。由 Elsevier Masson SAS 出版。保留所有权利

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