Alaswad Mohammed
Comprehensive Cancer Centre, Radiation Oncology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia.
Rep Pract Oncol Radiother. 2023 Jun 26;28(2):286-303. doi: 10.5603/RPOR.a2023.0019. eCollection 2023.
The focus of this paper was to review and summarise the current issues and recent trends within the framework of locally advanced (LA) non-small cell lung cancer (NSCLC). The recently proposed 8 tumour-node-metastases (TNM) staging system exhibited significant amendments in the distribution of the T and M descriptors. Every revision to the TNM classification should contribute to clinical improvement. This is particularly necessary regarding LA NSCLC stratification, therapy and outcomes. While several studies reported the superiority of the 8 TNM edition in comparison to the previous 7 TNM edition, in terms of both the discrimination ability among the various T subgroups and clinical outcomes, others argued against this interpretation. Synergistic cytotoxic chemotherapy with radiotherapy is most prevalent in treating LA NSCLC. Clinical trial experience from multiple references has reported that the risk of locoregional relapse and distant metastasis was less evident for patients treated with concomitant radiochemotherapy than radiotherapy alone. Nevertheless, concern persists as to whether major incidences of toxicity may occur due to the addition of chemotherapy. Cutting-edge technologies such as four-dimensional computed tomography (4D-CT) and volumetric modulated arc therapy (VMAT) should yield therapeutic gains due to their capability to conform radiation doses to tumours. On the basis of the preceding notion, the optimum radiotherapy technique for LA NSCLC has been a controversial and much-disputed subject within the field of radiation oncology. Notably, no single-perspective research has been undertaken to determine the optimum radiotherapy modality for LA NSCLC. The landscape of immunotherapy in lung cancer is rapidly expanding. Currently, the standard of care for patients with inoperable LA NSCLC is concurrent chemoradiotherapy followed by maintenance durvalumab according to clinical outcomes from the PACIFIC trial. An estimated 42.9% of patients randomly assigned to durvalumab remained alive at five years, and free of disease progression, thereby establishing a new benchmark for the standard of care in this setting.
本文的重点是回顾和总结局部晚期（LA）非小细胞肺癌（NSCLC）框架内的当前问题和近期趋势。最近提出的8版肿瘤-淋巴结-转移（TNM）分期系统在T和M描述符的分布上有重大修订。TNM分类的每次修订都应有助于临床改善。这对于LA NSCLC的分层、治疗和预后尤其必要。虽然几项研究报告了8版TNM相对于之前的7版TNM在各个T亚组之间的区分能力和临床结果方面的优越性，但也有其他研究对此解释提出反对意见。同步细胞毒性化疗与放疗在LA NSCLC的治疗中最为普遍。多个参考文献的临床试验经验表明，与单纯放疗相比，接受同步放化疗的患者局部区域复发和远处转移的风险不太明显。然而，对于化疗的加入是否会导致主要毒性事件的发生，人们仍然存在担忧。诸如四维计算机断层扫描（4D-CT）和容积调强弧形放疗（VMAT）等前沿技术应因其使放射剂量与肿瘤相匹配的能力而带来治疗益处。基于上述观点，LA NSCLC的最佳放疗技术一直是放射肿瘤学领域中一个有争议且备受争议的话题。值得注意的是，尚未进行单一视角的研究来确定LA NSCLC的最佳放疗方式。肺癌免疫治疗的前景正在迅速扩展。目前，对于无法手术的LA NSCLC患者，标准治疗方案是同步放化疗，然后根据PACIFIC试验的临床结果给予度伐利尤单抗维持治疗。估计随机分配到度伐利尤单抗组的患者中有42.9%在五年时仍然存活且无疾病进展，从而为此种情况下的标准治疗树立了新的标杆。
