Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Division of Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL..
Semin Radiat Oncol. 2024 Apr;34(2):229-242. doi: 10.1016/j.semradonc.2023.12.005.
Sarcomas are a heterogeneous group of bone and soft tissue tumors. Survival outcomes for advanced (unresectable or metastatic) disease remain poor, so therapeutic improvements are needed. Radiotherapy plays an integral role in the neoadjuvant and adjuvant treatment of localized disease as well as in the treatment of metastatic disease. Combining radiotherapy with immunotherapy to potentiate immunotherapy has been used in a variety of cancers other than sarcoma, and there is opportunity to further investigate combining immunotherapy with radiotherapy to try to improve outcomes in sarcoma. In this review, we describe the diversity of the tumor immune microenvironments for sarcomas and describe the immunomodulatory effects of radiotherapy. We discuss studies on the timing of radiotherapy relative to immunotherapy and studies on the radiotherapy dose and fractionation regimen to be used in combination with immunotherapy. We describe the impact of radiotherapy on the tumor immune microenvironment. We review completed and ongoing clinical trials combining radiotherapy with immunotherapy for sarcoma and propose future directions for studies combining immunotherapy with radiotherapy in the treatment of sarcoma.
肉瘤是一组异质性的骨和软组织肿瘤。晚期（不可切除或转移性）疾病的生存结果仍然很差，因此需要治疗上的改进。放射治疗在局部疾病的新辅助和辅助治疗以及转移性疾病的治疗中发挥着重要作用。除肉瘤外，放射治疗与免疫治疗相结合以增强免疫治疗已在多种癌症中得到应用，有机会进一步研究将免疫治疗与放射治疗相结合，以试图改善肉瘤的治疗效果。在这篇综述中，我们描述了肉瘤的肿瘤免疫微环境的多样性，并描述了放射治疗的免疫调节作用。我们讨论了放射治疗与免疫治疗的时间关系的研究，以及与免疫治疗联合使用的放射治疗剂量和分割方案的研究。我们描述了放射治疗对肿瘤免疫微环境的影响。我们回顾了已完成和正在进行的联合放射治疗和免疫治疗肉瘤的临床试验，并为将免疫治疗与放射治疗相结合治疗肉瘤的研究提出了未来的方向。
