通过放射治疗对肺癌进行根治性治疗具有挑战性，因为呼吸运动和解剖结构的变化会增加放射治疗期间严重脱靶效应的风险。在线适应性放疗（ART）是一种不断发展的方法，可以在放疗间隔期间根据生理或解剖变化及时修改治疗计划，旨在改善肺癌患者的剂量分布，实现精确靶向和递送。在线ART的有效性取决于多个组件的无缝集成：足够质量的直线加速器集成成像引导、可变形图像配准、自动重建轮廓以及高效的质量保证和工作流程。本综述总结了肺癌在线 ART 的现状，包括关键技术，以及该领域的挑战和活跃研究领域。版权所有 © 2024 中华医学会，由 Wolters Kluwer, Inc. 制作，CC- BY-NC-ND 许可证。

Definitive treatment of lung cancer with radiotherapy is challenging, as respiratory motion and anatomical changes can increase the risk of severe off-target effects during radiotherapy. Online adaptive radiotherapy (ART) is an evolving approach that enables timely modification of a treatment plan during the interfraction of radiotherapy, in response to physiologic or anatomic variations, aiming to improve the dose distribution for precise targeting and delivery in lung cancer patients. The effectiveness of online ART depends on the seamless integration of multiple components: sufficient quality of linear accelerator-integrated imaging guidance, deformable image registration, automatic recontouring, and efficient quality assurance and workflow. This review summarizes the present status of online ART for lung cancer, including key technologies, as well as the challenges and areas of active research in this field.Copyright © 2024 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.