SCI
27 September 2024
Executive Summary of the American Radium Society® (ARS) Appropriate Use Criteria (AUC) for Non-Small Cell Lung Cancer in a Central/Ultra-Central Location: Systematic Review and Guidelines
（IF: Journal of Thoracic Oncology, 21）
Park HS, Rimner A, Amini A, Chang JY, Chun SG, Donington J, Edelman MJ, Gubens MA, Higgins KA, Iyengar P, Juloori A, Movsas B, Nemeth Z, Ning MS, Rodrigues G, Wolf A, Simone CB 2nd. Executive Summary of the American Radium Society® (ARS) Appropriate Use Criteria (AUC) for Non-Small Cell Lung Cancer in a Central/Ultra-Central Location: Systematic Review and Guidelines. J Thorac Oncol. 2024 Sep 11:S1556-0864(24)02268-8.
Corresponding Author:
Dr. Henry S. Park, M.D., M.P.H.
Associate Professor, Vice Chair for Clinical Research, and Chief of Thoracic Radiotherapy
Department of Therapeutic Radiology
Yale School of Medicine
Telephone: 203-200-2100
E-mail: henry.park@yale.edu
Definitive radiation therapy is considered standard therapy for medically inoperable early-stage non-small cell lung cancer (NSCLC). However, for patients with tumors located near to structures like the proximal tracheobronchial tree, esophagus, heart, spinal cord, and brachial plexus, the optimal management regimen is controversial. The objective was to develop expert multidisciplinary consensus guidelines on the management of medically inoperable NSCLC located in a central or ultra-central location relative to critical organs-at-risk.
对于无法手术的早期非小细胞肺癌（NSCLC），确定性放疗被认为是标准治疗方法。然而，对于肿瘤位于类似近端气管支气管树、食管、心脏、脊髓和臂丛神经等结构附近的患者，最佳治疗方案存在争议。我们的目标是制定多学科专家共识指南，以管理位于相对于关键危险器官-危险区的中央或超中央位置的无法手术的 NSCLC。
Case variants regarding centrally and ultra-centrally located lung tumors were developed by the 15-member multidisciplinary American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) expert panel. A comprehensive review of the English medical literature was performed from 1/1/46 to 12/31/23 to inform consensus guidelines. Modified Delphi methodology was used by the panel to evaluate the variants and procedures, with ≤3 rating points from median defining agreement/consensus. The guideline was then approved by the ARS Executive Committee and released for public comment per established ARS procedures.
由15名多学科美国镭学会（ARS）胸腔适当使用准则（AUC）专家组成的专家小组，制定了关于位于中央和超中央位置的肺部肿瘤的病例变体。对从1946年1月1日至2023年12月31日，英文医学文献进行了全面回顾，以制定共识指南。专家小组使用改良的德尔菲法评估了变体和程序，中位数≤3个评分点被定义为达成共识/一致。随后ARS执行委员会批准了该指南，并根据ARS的既定程序发布以征求公众意见。
The Thoracic ARS AUC Panel identified 90 relevant references and obtained consensus in all variants. Radiotherapy alone was considered appropriate, with additional immunotherapy to be considered primarily in the clinical trial setting. Hypofractionated radiotherapy in 8-18 fractions was considered appropriate for ultra-central lesions near proximal tracheobronchial tree, upper trachea, and esophagus. For other ultra-central lesions near heart, great vessels, brachial plexus, and spine, or for non-ultra-central but still central lesions, 5-fraction SBRT was also considered an appropriate option. Intensity-modulated radiotherapy was considered appropriate and 3D-conformal radiotherapy inappropriate for all variants. Other treatment planning techniques to decrease the risk of overdosing critical organs-at-risk were also considered.
胸外科ARS AUC小组确定了90篇相关参考文献，并在所有变体上达成共识。单独放疗被认为是合适的，在临床试验环境中主要考虑额外的免疫治疗。对于近端气管支气管树、上气管和食管附近的超中央病灶，8-18次分割的超分割放疗被认为是合适的。对于心脏、大血管、臂丛神经和脊柱附近的其他超中央病灶，或者对于非超中央但仍为中央的病灶，5次分割的SBRT（立体定向放射治疗）也被认为是一个合适的选项。对于所有变体，调强放疗被认为是合适的，而3D适形放疗则被认为是不可取的。还考虑了其他治疗计划技术来降低对关键器官-危险区的过量风险。
The ARS Thoracic AUC panel has developed multidisciplinary consensus guidelines for various presentations of stage I NSCLC in a central or ultra-central location.
ARS胸外科AUC小组已经为位于中央或超中央位置的I期NSCLC的各种表现制定了多学科共识指南。
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