Abstract：
Stereotactic ablative radiotherapy (SABR) is increasingly used for the treatment of early-stage non-small cell lung cancer (ES-NSCLC) and for pulmonary metastases. In patients with ES-NSCLC, SABR is highly successful with reported 5-year local control rates of approximately 90%. However, the assessment of local control following lung SABR can be challenging as radiological changes arising from radiation-induced lung injury (RILI) can be observed in up to 90% of patients. These so-called \'benign\' radiological changes evolve with time and are often asymptomatic. Several radiological and metabolic features have been explored to help distinguish RILI from local recurrences (LR). These include the Response Evaluation Criteria for Solid Tumors (RECIST), high-risk features (HRF\'s) and maximum standardized uptake value (SUVmax) on FDG-PET-CT. However, use of some of these approaches have poor predictive values and low specificity for recurrence. A proposed new workflow for the evaluation of post-lung SABR radiological changes will be reviewed which uses the presence of so-called \'actionable radiological features\' to trigger changes to imaging schedules and identifies the need for a multidisciplinary board review. Furthermore, this critical review of post-lung SABR imaging will highlight current challenges, new insights, and unknowns in this field.
摘要：
立体定向消融放疗（SABR）越来越多地用于治疗早期非小细胞肺癌（ES-NSCLC）和肺转移。在ES-NSCLC患者中，SABR非常成功，报告的5年局部控制率约为90％。然而,由于高达90%的患者可以观察到由放射性肺损伤(RILI)引起的放射学变化,因此评估肺SABR后的局部控制可能具有挑战性.这些所谓的“良性”放射学变化随时间演变，通常无症状。已经探索了几种放射学和代谢特征来帮助区分RILI和局部复发(LR)。这些包括实体瘤的反应评估标准（RECIST），FDG-PET-CT的高危特征（HRF）和最大标准化摄取值（SUVmax）。然而,使用其中一些方法对复发的预测价值较差,特异性较低.将审查用于评估肺后SABR放射学变化的拟议新工作流程，该工作流程使用所谓的“可操作放射学特征”的存在来触发成像时间表的变化，并确定是否需要进行多学科委员会审查。此外，这项关于肺后SABR成像的重要回顾将突出当前的挑战，新的见解，在这个领域是未知的。
