Saddi Jessica, Santos Hernandez David Alberto, Stella Giulia Maria, Galli Giulia, Borgetto Sabrina, Bonzano Elisabetta, Lancia Andrea, La Mattina Salvatore, Colombo Sara, Squillace Luigi, Baietto Guido, Bortolotto Chandra, D'Ambrosio Gioacchino, Mantovani Laura, Pedrazzoli Paolo, Agustoni Francesco
San Matteo Hospital Foundation (IRCCS), Pavia, Italy.
Department of Radiation Oncology, Centro Nacional de Radioterapia, San Salvador, El Salvador.
Front Oncol. 2025 Aug 15;15:1642564. doi: 10.3389/fonc.2025.1642564. eCollection 2025.
Radiation therapy is used in the clinical scenario of oligo-metastatic lung cancer as a weapon to delay the subsequent line of systemic therapy, particularly in the case of oligo-progressive disease. In this setting, the integration of immunotherapy and radiotherapy plays an important role to achieve local control and improve progression-free survival (PFS).
We reported the case of an elderly fragile patient affected by advanced non-small cell lung cancer treated with pembrolizumab as first systemic line and immuno-modulant radiation therapy at oligo-progression. More specifically, he underwent stereotactic body radiation therapy using non-ablative regimen (24 Gy in 3 fractions) achieving partial response with abscopal effect and without drug interruption. After one year, during immunotherapy mediastinal and parenchymal progression occurred and he received another radiation treatment using conventional non-ablative regimen (40 Gy in 20 fractions). Complete response was observed without severe side effects (his poor respiratory function did not change during both treatments).
In this case report we showed that the association of immunotherapy and non-ablative radiation regimens may represent a safe and effective strategy to achieve complete response also in fragile patients, in whom the burden of side effects should be prioritized.
放射治疗在寡转移肺癌的临床治疗中被用作延缓后续全身治疗的手段，尤其是在寡进展性疾病的情况下。在这种情况下，免疫治疗与放射治疗的联合对于实现局部控制和改善无进展生存期（PFS）起着重要作用。
我们报告了一例老年体弱患者，患有晚期非小细胞肺癌，一线全身治疗采用帕博利珠单抗，寡进展时采用免疫调节放射治疗。具体而言，他接受了非消融方案的立体定向体部放射治疗（24 Gy分3次），获得了部分缓解并出现了远隔效应，且未中断用药。一年后，在免疫治疗期间出现了纵隔和实质进展，他接受了另一次常规非消融方案的放射治疗（40 Gy分20次）。观察到完全缓解，且无严重副作用（在两次治疗期间他的呼吸功能较差的情况均未改变）。
在本病例报告中，我们表明免疫治疗与非消融放射方案的联合可能是一种安全有效的策略，即使在体弱患者中也能实现完全缓解，在这类患者中应优先考虑副作用负担。
