Kępka Lucyna
Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland.
Cancers (Basel). 2024 Aug 29;16(17):3018. doi: 10.3390/cancers16173018.
Palliative thoracic radiotherapy provides rapid and effective symptom relief in approximately two-thirds of NSCLC patients treated. In patients with poor performance status, the degree of palliation appears unrelated to the radiation dose or fractionation schedule. Conversely, in patients with good performance status, higher radiation doses administered over longer periods have shown modest survival benefits. These findings stem from studies conducted before the advent of immunotherapy and targeted therapy in clinical practice. Currently, there are no large prospective studies specifically dedicated to palliative radiotherapy conducted in this new treatment era. Modern radiotherapy technologies are now widely available and are increasingly used for palliative purposes in selected patients, reflecting the expanded array of therapeutic options for disseminated NSCLC and improved prognosis. Some traditional tenets of palliative thoracic radiotherapy, such as the improvement of overall survival with a protracted radiation schedule and the use of simple, cost-effective radiation techniques for palliative purposes, may no longer hold true for patients receiving immunotherapy or targeted therapy. The application of IMRT or SBRT in the context of palliative radiotherapy for NSCLC is not yet sufficiently explored, and this is addressed in this review. Moreover, new risks associated with combining palliative radiotherapy with these systemic treatments are being explored and are discussed within the context of palliative care. The optimal timing, doses, fractionation schedules, and treatment volumes for radiotherapy combined with immunotherapy or targeted therapy are currently subjects of investigation. In emergencies, radiotherapy should be used as a life-saving measure without delay. However, for other indications of palliative thoracic radiotherapy, decisions regarding doses, timing relative to systemic treatments, and treatment volumes should be made in a multidisciplinary context, considering the patient's prognosis, anticipated outcomes, and access to potentially effective treatments. We still lack robust data from prospective studies on this matter. This review examines and discusses available evidence on the use of palliative thoracic radiotherapy within the framework of modern treatment strategies for NSCLC.
姑息性胸部放疗能使约三分之二接受治疗的非小细胞肺癌（NSCLC）患者迅速有效地缓解症状。在身体状况较差的患者中，姑息治疗程度似乎与辐射剂量或分割方案无关。相反，在身体状况良好的患者中，较长时间给予较高辐射剂量已显示出适度的生存获益。这些发现源于免疫疗法和靶向疗法在临床实践中出现之前所进行的研究。目前，在这个新的治疗时代，尚无专门针对姑息性放疗的大型前瞻性研究。现代放疗技术现已广泛应用，并越来越多地用于选定患者的姑息治疗，这反映了针对播散性NSCLC的治疗选择范围扩大以及预后改善。姑息性胸部放疗的一些传统原则，如延长放疗方案可提高总生存率以及使用简单、经济有效的放疗技术用于姑息治疗，对于接受免疫疗法或靶向疗法的患者可能不再适用。调强放疗（IMRT）或立体定向体部放疗（SBRT）在NSCLC姑息性放疗中的应用尚未得到充分探索，本综述将对此进行阐述。此外，正在探索将姑息性放疗与这些全身治疗相结合所带来的新风险，并在姑息治疗的背景下进行讨论。放疗联合免疫疗法或靶向疗法的最佳时机、剂量、分割方案和治疗体积目前仍是研究课题。在紧急情况下，应立即将放疗用作挽救生命的措施。然而，对于姑息性胸部放疗的其他适应证，应在多学科背景下做出关于剂量、相对于全身治疗的时机以及治疗体积的决策，同时考虑患者的预后、预期结果以及获得潜在有效治疗的机会。在这个问题上，我们仍然缺乏来自前瞻性研究的有力数据。本综述在NSCLC现代治疗策略的框架内，审视并讨论了关于姑息性胸部放疗应用的现有证据。
