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The standard treatment for locally advanced non-small cell lung cancer (NSCLC) is radiotherapy concurrent with chemotherapy, but the survival was not satisfied. With the development of intensity modulated radiotherapy, simultaneous integrated boost technique (SIB) becomes the research direction of locally advanced NSCLC. The aim of this study is to investigate the efficacy and safety of SIB intensity modulated radiotherapy technique for locally advanced NSCLC.We retrospectively reviewed the clinical data of locally advanced NSCLC who were treated with radiotherapy by SIB technique in Peking University Cancer Hospital from June 2015 to December 2018. Kaplan-Meier method was used for analysis.Ninty-three patients were included in the analysis. After a median follow-up of 34.23 months, 3-year overall survival (OS), progression-free survival (PFS), local-recurrence free survival (LRFS) and metastasis free survival (MFS) rates were 53.0%, 37.0%, 50.5% and 50.5%, respectively. The incidence of grade ≥3 esophagitis was 5.4%. There were 2 (2.2%) patients experiencing grade ≥3 radiation-related pneumonia.Radiation with SIB intensity modulated radiotherapy technique is effective and safe for patients with locally advanced NSCLC.【中文题目：同步推量调强放疗在局部晚期非小细胞肺癌中的应用】 【中文摘要：背景与目的 局部晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）的标准治疗方案为放疗联合化疗，但其生存仍不令人满意。随着调强放疗技术的发展，同步推量（simultaneous integrated boost, SIB）技术成为局部晚期NSCLC的研究方向。本研究拟探讨局部晚期NSCLC采用SIB调强放疗技术的有效性和安全性。方法 回顾性分析北京大学肿瘤医院2015年6月-2018年12月采用SIB技术进行放疗的局部晚期NSCLC患者资料，采用Kaplan-Meier方法进行统计分析，分析其疗效、生存及治疗相关毒性。结果 研究纳入93例患者，中位随访时间34.23个月，3年生存率、无进展生存率、无局部区域复发生存率和无远处转移生存率分别为53.0%、37.0%、50.5%和50.5%。3级放射性食管炎发生率为5.4%，≥3级放射性肺炎发生率为2.2%。结论 局部晚期NSCLC采用SIB调强放疗技术安全有效。】 【中文关键词：肺肿瘤；同步推量；有效性】.

Twice-daily radiation concurrent with chemotherapy is one of the standard methods for limited-stage small cell lung cancer. The study was to evaluate the feasibility of chemotherapy concurrent with dose-escalating twice-daily radiotherapy by simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) approach in patients with limited-stage small cell lung cancer.Patients with limited-stage small cell lung cancer were included, treated with twice-daily radiotherapy by SIB-IMRT concurrent with chemotherapy of etoposide plus cisplatin. Dose escalation was conducted by "classical" 3+3 methods with three patients enrolled in each dose level. The therapeutic gross tumor volume (GTV) was treated according to three consecutive dose levels i.e., 45 Gy at 1.5 Gy twice daily, 50 Gy at 1.67 Gy twice daily and 54 Gy at 1.8 Gy twice daily. The planning target volume (PTV) received a dose of 45 Gy delivered in 30 fractions of 1.5 Gy. The primary endpoints were acute toxicities. The secondary endpoints included overall survival (OS), progression-free survival (PFS) and loco-regional failure-free survival (LRFFS) at 1-year of follow-up.Twenty men and six women were included. The median age was 52 (30-68) months. 12 patients experienced grade 2 acute esophagitis, and 1 patient developed grade 3 acute esophagitis. Only 3 patients developed Grade 2 pneumonitis. Grade 3 or higher radiation-related pneumonia was not observed. None died of treatment-related causes. With median follow-up of 11.2 months (3.2-36.2 months), 1-year OS, PFS and LRFFS were 89.0%, 51.0% and 85.0%, respectively.Dose escalation for twice-daily radiation concurrent with chemotherapy in LS-SCLC has been safely achieved up to 54 Gy for GTV using SIB-IMRT technique.背景与目的 同步放化疗是局限期小细胞肺癌的标准治疗，但患者局部复发率和远处转移率仍较高，本研究旨在评估同步推量调强放疗治疗局限期小细胞肺癌的安全性和有效性。方法 符合局限期小细胞肺癌的患者纳入研究行同步放化疗，放疗采用每日两次方案，应用经典“3+3”模式对肿瘤大体体积（gross target volume, GTV）进行同步推量剂量递增，设定为三个剂量梯度，分别为45 Gy/30 f（单次剂量1.50 Gy）、50 Gy/30 f（单次剂量1.67 Gy）和54 Gy/30 f（单次剂量1.80 Gy）。计划靶体积均为45 Gy/30 f。主要研究终点为放疗期间及结束3个月内毒性反应。次要研究终点包括1年生存率、无进展生存期、局部无进展生存期。结果 研究共入组26例患者，中位年龄为52岁（30岁-68岁）。26例患者中，1例出现3级放射性食管炎，未观察到3级及以上放射性肺炎。中位随访时间11.2（3.2-36.2）个月，1年生存率、无进展生存率和局部无进展生存率分别为89.0%、51.0%和85.0%。结论 局限期小细胞肺癌采用化疗联合同步推量调强放疗，将GTV由45 Gy提升至54 Gy是安全有效的。.

High level evidence from randomized studies comparing stereotactic ablative radiotherapy (SABR) to surgery is lacking. Although the results of pooled analysis of two randomized trials for STARS and ROSEL showed that SABR is better tolerated and might lead to better overall survival than surgery for operable clinical stage I non-small cell lung cancer (NSCLC), SABR, however, is only recommended as a preferred treatment option for early stage NSCLC patients who cannot or will not undergo surgery. We, therefore, are waiting for the results of the ongoing randomized studies [Veterans affairs lung cancer surgery or stereotactic radiotherapy in the US (VALOR) and the SABRTooth study in the United Kingdom (SABRTooths)]. Many retrospective and case control studies showed that SABR is safe and effective (local control rate higher than 90%, 5 years survival rate reached 70%), but there are considerable variations in the definitions and staging of lung cancer, operability determination, and surgical approaches to operable lung cancer (open vs video-assisted). Therefore, it is difficult to compare the superiority of radiotherapy and surgery in the treatment of early staged lung cancer. Most studies demonstrated that the efficacy of the two modalities for early staged lung cancer is equivalent; however, due to the limited data, the conclusions from those studies are difficult to be evidence based. Therefore, the controversies will be focusing on the safety and invasiveness of the two treatment modalities. This article will review the ongoing debate in light of these goals.目前比较立体定向消融放疗（stereotactic ablative radiotherapy, SABR）与手术治疗早期非小细胞肺癌（non-small cell lung cancer, NSCLC）的随机研究证据尚不多，高水平的循证医学证据更是缺乏。尽管STARS和ROSEL两项随机研究结果荟萃分析显示SABR较手术耐受性更好，生存不劣于手术，但是目前仍仅推荐拒绝手术或不可手术的早期NSCLC首选SABR，期待着正在进行的随机研究VALOR（Veterans Affairs Lung Cancer Surgery or Stereotactic Radiotherapy in the US）和SABRTooth（SABRTooth study in the United Kingdom）的结果。许多回顾性的研究和病例对照研究显示了SABR治疗的安全性和有效性（局部控制率达90%以上，5年生存率达70%），但是由于肿瘤分期定义、如何决定可否手术及手术患者采用手术方式（开胸或胸腔镜辅助）等不同，很难比较SABR和手术的优劣，尽管大部分结论是两种方法疗效相似，但难以成为循证医学证据，因此争论热点是哪一种方法更安全、创伤更小。本文将就以上争论热点进行述评。.

Osteosarcoma is the most frequent primary cancer of bone. The incidence is higher in adolescents. Large improvement, though, has been made in the treatment of osteosarcoma under the framework of multidisciplinary team, an important prognostic factor for osteosarcoma is pulmonary metastasis. Surgical resection of lung metastases is widely accepted as the optimal modality in osteosarcoma patients. Undoubtedly, surgical resection of lung metastases is widely accepted as the optimal modality in osteosarcoma patients. However, since current conceptions within the surgical approach to lung metastasectomy involve multidisciplinary collaboration, which are highly variable,there is not neither consensus nor standardized practice patterns. We conduct a survey aiming to reveal areas of consistency in current clinical practice on lung metastasectomy among Chinese osteosarcoma high volume centers.A questionnaire survey specific to the nationwide high volume centers of osteosarcoma was conducted from September 2015 to November 2015. Analyses were stratified by hospital, working duration, case volume and medical discipline.Of 150 invited physicians, 105 participated, resulting in an overall response rate of 70%. Forty-one percent of the responded physicians agreed with the statement that orthopedic oncology should play a predominant role in the multidisciplinary team. More than 64% of respondents chose metastasectomy as the preferred local control approach, and up to 78.1% of respondents recommended pulmonary metastasectomy for patients. Compared with orthopedic surgeons, other physicians were significantly more likely to report not advocating pulmonary metastasectomy in their practice (OR(others)=0.02; 95%CI: 0.00-0.22; P=0.001), and thoracic surgeons were more likely to decide metastasectomy according to indications rather than the number limit of metastases (OR(thoracic surgeons)=20.93; 95%CI: 2.05-213.64; P=0.001). For the most preferred radiographic evaluation option, approximately 83% of respondents reported diagnostic use of computed tomography (CT). More than 70% of respondents reported that chest CT follow-up should be 3 months after the primary site resection; approximately 68% deemed the diagnostic accuracy of CT about 90%; most respondents (92%) recommended the extrapulmonary imaging evaluation simultaneously. Around 46% of respondents reported that survival duration longer than 6 months after pulmonary metastasectomy is beneficial.This study offers new information about the variability in the reported management of pulmonary metastatic osteosarcoma in China, reflecting the deficiencies in unified practice patterns. The results of this survey also provide baseline data for future research and for the development of international guidelines.背景与目的 骨肉瘤是最常见的骨原发恶性肿瘤，好发于青少年。尽管多学科框架下骨肉瘤的治疗已经取得瞩目成就，然而影响骨肉瘤远期生存的重要因素是肺转移。约有 1/2 以上患者在其病程的不同时期会发生肺转移，其中 10%~15%为同时性肺转移。毋庸置疑，治疗肺转移瘤的首选方法为外科切除，但因骨肉瘤肺转移的诊疗涉及多学科多专业，而由于各学科之间的理念存在差异，因此尚未形成标准化的诊疗模式。本研究通过问卷调查方式旨在了解当前我国骨肉瘤大型医疗中心在此领域中的诊疗模式现况。方法 2015年9月-2015年11月期间，一项关于骨肉瘤肺转移的诊疗现况问卷在全国骨肉瘤大型诊疗中心范围内开展。根据调查对象所在单位、工作年限、年均收治病例数及医学专业不同，进一步行分层分析。结果 调查共发放问卷150份，回收有效问卷105份，总应答率为70%。首先，关于骨肉瘤肺转移治疗的核心问题，41.0%的调查对象认同骨肿瘤外科专业在骨肉瘤肺转移多学科诊疗实践中的主导地位；首选肺转移瘤切除术作为转移灶局部控制措施的比例约64%；78.1%的调查对象会推荐患者行肺转移瘤切除术；骨科及胸外科医师较之其他专业更加积极（同骨科专业相比，OR其他专业=0.02；95%CI：0.00-0.22；P=0.001）；胸外科医师更倾向根据经验决定肺转移瘤切除术的指证，而非受限于病灶具体数目（OR胸外科专业=20.93；95%CI：2.05-213.64；P=0.001）。其次，关于骨肉瘤肺转移影像学诊断方法，约83%首选胸部计算机断层扫描（computed tomography, CT）；约70%的调查对象推荐原发灶切除术后3个月行胸部CT随诊；约68%认为CT诊断准确度90%水平；约92%同时推荐行肺外影像学评估。最后，关于术后生存获益的定义问题，约46%认为肺转移瘤术后生存期超过6个月即为生存获益。结论 本次问卷调查提供了我国骨肉瘤肺转移诊疗模式的现况信息，其反映出缺少统一规范诊疗模式的不足。调查结果为今后研究方向及国际性临床指南提供了基线数据。.

With the rapid development of technology, stereotactic radiotherapy has been widely used. In a cohort of medically operable non-small cell lung cancer patients receiving stereotactic body radiation therapy (SBRT) survival rates "potentially equivalent to those of surgery" have been reported. Removing the field flattening filter, Clinac is capable of delivering dose rates much higher than conventional linac as well as reducing the treatment time. The goals of this work were to report safety and efficacy of SBRT treatment using a flattening filter-free model for non-small cell lung cancer (NSCLC) with small lesions.From December 2011 to December 2013, 31 NSCLC patients who were T1-2N0M0, solitary pulmonary recurrence after surgery, and stage IV with oligo metastasis were enrolled, receiving SBRT treatment (60 Gy/8 f or 48 Gy/4 f) applying a flattening filter-free model.Compared with conventional technique, flattening filter-free model shortened the treating time with equivalent target dose and normal tissue dose. The median follow-up time is 19.4 mo. The 1-yr local control, regional control, distant control, progression free survival and overall survival rates were 96.8%, 96.8%, 83.9%, 77.4% and 96.8%. The most common side effects were radiation pneumonitis (29% grade 1, 3.2% grade 2) and chest pain (12.9% grade 1, 6.5% grade 2).The use of flattening filter-free model in SBRT for small lesions of NSCLC patients is safe and effective. Long time follow-up and additional studies are still needed to validate our conclusions.背景与目的 随着放疗技术的快速发展，立体定向放射治疗（stereotactic body radiation therapy, SBRT）已得到广泛应用，且在早期非小细胞肺癌（non-small cell lung cancer, NSCLC）治疗中取得与手术相当的疗效。非均整模式移除了加速器的射野均整器，其剂量率远高于常规均整模式，缩短治疗时间，但目前临床应用较少。本研究旨在探讨非均整模式SBRT治疗的安全性和有效性。方法 选取2011年12月-2013年12月期间的T1-2N0M0原发NSCLC，术后肺内孤立复发转移，以及IV期肺内寡转移灶者共31例，予以内在大体肿瘤靶区60 Gy/8 f或48 Gy/4 f的非均整模式SBRT治疗。结果 非均整模式比常规均整模式明显缩短了治疗时间，靶区剂量相当，且未增加正常组织受量。患者中位随访时间为19.4个月。1年的局部控制、区域控制、远处转移控制、无疾病进展和总生存率分别为96.8%、96.8%、83.9%、77.4%和96.8%。最常见的副反应为放射性肺炎（1级29%，2级3.2%）和胸痛（1级12.9%，2级6.5%），发生率较低。结论 相比既往常规均整模式，使用非均整模式大分割放射治疗技术治疗肺部小肿瘤是安全、有效的，但长期效果仍需进一步随访、研究。.