Oncology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Division of Radiation Oncology, University of British Columbia/BC Cancer, Victoria, British Columbia, Canada.
Clin Oncol (R Coll Radiol). 2020 Nov;32(11):758-765. doi: 10.1016/j.clon.2020.07.021. Epub 2020 Aug 27.
The new systemic therapies for cancer are having major impacts on the prognosis of patients with advanced cancers, some achieving long-term survival with targeted therapy or immune checkpoint inhibitors. Interactions of radiotherapy with the new systemic therapies are reviewed. Many agents increase radiosensitivity and particular caution is required combining BRAF inhibitors and radiotherapy because of significant toxicity. Most new systemic therapies can be used safely with palliative doses of radiotherapy, but it is important to be aware of overlapping toxicities depending on the site treated. DNA damage response modulators increase radiosensitivity and may potentially increase radiation toxicity but are at an earlier stage of development. Stereotactic ablative radiotherapy may produce further survival gains in patients responding to targeted therapy and immunotherapy.
新的癌症系统疗法正在对晚期癌症患者的预后产生重大影响，一些患者通过靶向治疗或免疫检查点抑制剂实现了长期生存。本文综述了放疗与新的系统疗法的相互作用。许多药物可增加放射敏感性，需要特别注意联合应用 BRAF 抑制剂和放疗，因为其毒性显著。大多数新的系统疗法可以与姑息剂量的放疗安全使用，但重要的是要意识到根据治疗部位，存在重叠毒性。DNA 损伤反应调节剂可增加放射敏感性，并可能增加放射毒性，但处于早期开发阶段。立体定向消融放疗可能会使对靶向治疗和免疫治疗有反应的患者获得进一步的生存获益。
