Zhu Zhengfei, Ni Jianjiao, Cai Xuwei, Su Shengfa, Zhuang Hongqing, Yang Zhenzhou, Chen Ming, Ma Shenglin, Xie Conghua, Xu Yaping, Li Jiancheng, Ge Hong, Liu Anwen, Zhao Lujun, Rao Chuangzhou, Xie Congying, Bi Nan, Hui Zhouguang, Zhu Guangying, Yuan Zhiyong, Wang Jun, Zhao Lina, Zhou Wei, Rim Chai Hong, Navarro-Martin Arturo, Vanneste Ben G L, Ruysscher Dirk De, Choi J Isabelle, Jassem Jacek, Chang Joe Y, Kepka Lucyna, Käsmann Lukas, Milano Michael T, Van Houtte Paul, Suwinski Rafal, Traverso Alberto, Doi Hiroshi, Suh Yang-Gun, Noël Georges, Tomita Natsuo, Kowalchuk Roman O, Sio Terence T, Li Baosheng, Lu Bing, Fu Xiaolong
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Transl Lung Cancer Res. 2022 Sep;11(9):1763-1795. doi: 10.21037/tlcr-22-644.
Lung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) accounting for most cases. While radiotherapy has historically served as a palliative modality in metastatic NSCLC, considerable advances in its technology and the continuous development of cutting-edge therapeutic agents, such as targeted therapy and immune checkpoint inhibitors (ICIs), are increasing its role in the multi-disciplinary management of the disease.
International radiotherapy experts were convened to consider and reach consensuses on the clinical utilities of radiotherapy in metastatic NSCLC, with the aim to provide patient-focused, up to date, evidence-based, recommendations to assist cancer specialists in the management of patients with metastatic NSCLC worldwide.
Timely radiotherapy can offer rapid symptom alleviation and allow subsequent aggressive treatment approaches in patients with heavy tumor burden and/or oncologic emergencies. In addition, appropriate incorporation of radiotherapy as concurrent, consolidation, or salvage therapy makes it possible to achieve long-term survival, or even cure, for patients with oligo-metastatic disease. Cranial radiotherapy plays an important role in the management of brain metastasis, potentially augmenting the response and prolonging survival associated with targeted agents and ICIs. However, key questions remain, such as the appropriate choice of radiation techniques, optimal sequence of systemic therapies and radiotherapy, and optimal patient selection for such combination strategies. Although a strong rationale for combining radiotherapy and ICIs exists, its optimal parameters in this setting remain to be established.
In the modern era, radiotherapy serves not only as a palliative tool in metastatic NSCLC, but also plays active roles in patients with oligo-focal disease, CNS metastasis and receiving ICIs.
肺癌是全球癌症相关死亡的主要原因，其中非小细胞肺癌（NSCLC）占大多数病例。虽然放射治疗在历史上一直是转移性NSCLC的姑息治疗方式，但随着其技术的显著进步以及靶向治疗和免疫检查点抑制剂（ICI）等前沿治疗药物的不断发展，放射治疗在该疾病的多学科管理中的作用日益增强。
召集国际放射治疗专家，就放射治疗在转移性NSCLC中的临床应用进行审议并达成共识，旨在提供以患者为中心、最新的、基于证据的建议，以协助全球癌症专家管理转移性NSCLC患者。
及时进行放射治疗可迅速缓解症状，并使肿瘤负荷重和/或出现肿瘤急症的患者能够采取后续积极的治疗方法。此外，将放射治疗适当地作为同步、巩固或挽救治疗，可以使寡转移疾病患者实现长期生存甚至治愈。全脑放疗在脑转移的管理中发挥着重要作用，可能增强与靶向药物和ICI相关的反应并延长生存期。然而，关键问题仍然存在，例如放射技术的合适选择、全身治疗和放射治疗的最佳顺序以及此类联合策略的最佳患者选择。尽管将放射治疗与ICI联合使用有充分的理论依据，但在这种情况下其最佳参数仍有待确定。
在现代，放射治疗不仅是转移性NSCLC的姑息治疗工具，而且在寡转移病灶、中枢神经系统转移和接受ICI治疗的患者中也发挥着积极作用。
