Vojtíšek Radovan
Department of Oncology and Radiotherapy, University Hospital in Pilsen, Pilsen, Czech Republic.
Faculty of Medicine, Charles University, Pilsen, Czech Republic.
Rep Pract Oncol Radiother. 2025 Aug 7;30(3):385-395. doi: 10.5603/rpor.107745. eCollection 2025.
In the recent years, the clinical stage where the cancer has spread beyond the primary site, but has not yet metastasised extensively, and which is known as oligometastatic disease (OMD), has become an object of interest to radiation oncologists. OMD is a kind of an "umbrella term" for a variety of clinical situations. This review focuses on the role of radiotherapy (RT) in the treatment of oligometastatic non-small cell lung cancer (OM-NSCLC). Currently, a wide range of techniques and fractionation regimens are used to treat OM-NSCLC and, unfortunately, it is not yet possible to determine which approach is the most effective. Therefore, more than ever, we should use the concept of risk-adapted RT and consider many factors when choosing the fractionation regimen and total dose applied. For different clinical scenarios, we set different treatment goals and derive different RT techniques and fractionations. Oligoprogression (OP) is a specific type of OMD that is increasingly encountered in clinical situations, probably due to the increased use of targeted therapy and the subsequent acquired resistance of a certain subpopulation of tumour cells. OP is the progression of a limited number of metastases after an initial response to systemic therapy. The rationale for using RT in areas of progression is to overcome tumour resistance in these progressive lesions. A number of trials are currently underway to find the optimal RT techniques for the most appropriate patients at a precise clinical stage.
近年来，癌症已扩散至原发部位以外但尚未广泛转移的临床阶段，即寡转移疾病（OMD），已成为放射肿瘤学家关注的对象。OMD是多种临床情况的“统称”。本综述重点关注放射治疗（RT）在寡转移非小细胞肺癌（OM-NSCLC）治疗中的作用。目前，广泛使用各种技术和分割方案来治疗OM-NSCLC，遗憾的是，尚无法确定哪种方法最有效。因此，我们比以往任何时候都更应运用风险适应放疗的概念，并在选择分割方案和应用的总剂量时考虑诸多因素。针对不同的临床情况，我们设定不同的治疗目标，并得出不同的RT技术和分割方式。寡进展（OP）是OMD的一种特殊类型，在临床中越来越常见，这可能是由于靶向治疗的使用增加以及随后肿瘤细胞特定亚群产生获得性耐药所致。OP是在对全身治疗产生初始反应后，有限数量转移灶的进展。在进展部位使用RT的基本原理是克服这些进展性病变中的肿瘤耐药性。目前正在进行多项试验，以在精确的临床阶段为最合适的患者找到最佳的RT技术。
