Radiation Oncology Unit, Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy.
Division of Oncology, Department of Oncology and Hematology, Modena University Hospital, 41124 Modena, Italy.
Int J Mol Sci. 2023 Jan 18;24(3):1892. doi: 10.3390/ijms24031892.
Locally advanced non-small-cell lung cancer still represents a "grey zone" in terms of the best treatment choice and optimal clinical outcomes. Indeed, most patients may be suitable to receive different treatments with similar outcomes such as chemo-radiotherapy (CHT-RT) followed by immunotherapy (IO) or surgery followed by adjuvant local/systemic therapies. We report a clinical case of a patient submitted to primary thoracic surgery who developed a mediastinal nodal recurrence successfully treated by CHT-RT-IO. Subsequently, a single brain lesion was found to have been successfully treated by single fraction stereotactic ablative radiotherapy. The patient is still on follow-up and she is free from disease having a good quality of life. In this report, we also perform a mini review about the role of CHT-RT followed by IO in treating loco-regional relapse after surgery. The role of SABR after IO is also evaluated, finding that it is safe and well tolerated. More robust and larger clinical data are needed in this particular setting to better define the role of the combination of systemic and local treatments in the management of intrathoracic and intracranial relapse for patients already submitted to CHT-RT followed by immunotherapy.
局部晚期非小细胞肺癌在治疗选择和最佳临床结果方面仍然是一个“灰色地带”。事实上，大多数患者可能适合接受不同的治疗方法，如化疗放疗（CHT-RT）后免疫治疗（IO）或手术加辅助局部/全身治疗，这些治疗方法的结果相似。我们报告了一例患者，该患者接受了原发性胸部手术，随后纵隔淋巴结复发，成功地接受了 CHT-RT-IO 治疗。随后，发现单发脑转移灶已成功接受单次分割立体定向消融放疗。患者仍在随访中，无疾病，生活质量良好。在本报告中，我们还对手术后局部区域复发接受 CHT-RT 后 IO 治疗的作用进行了小型综述。还评估了 IO 后 SABR 的作用，发现其安全且耐受良好。在这种特定情况下，需要更强大和更大的临床数据来更好地定义已接受 CHT-RT 后免疫治疗的患者，在管理胸内和颅内复发时，全身治疗和局部治疗联合应用的作用。
