肺癌放疗与免疫治疗的实践与展望

doi:10.3760/cma.j.cn113030-20200918-00471

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摘要免疫治疗是近年来肿瘤治疗领域热门话题。无论是Keynote189研究还是Keynote407研究均证实在肺癌中免疫检查点抑制剂获益人群的无进展生存期显著延长。2012年《新英格兰医学杂志》发表的一篇文章中,免疫联合放疗产生放射远隔效应的个案报道引起肿瘤界强烈关注。2017年公布的Pacific研究结果将免疫治疗在非小细胞肺癌中的适应证从晚期扩展到了局部晚期。同年发表在《柳叶刀·肿瘤学》杂志上的Keynote001二次分析结果提示放疗可能会介导免疫记忆效应,但其产生机制、时间窗等问题目前尚不清楚。随着近年来PEMBRO-RT研究及我们团队多项工作的结果,放疗联合免疫治疗(iRT)的各种细节日渐成熟。在临床工作中iRT涉及肺癌的全程治疗,但不是大杂烩和乱炖,需进一步优化和梳理。本文就iRT的原理、临床实践的疗效以及对具体细节的探索进行讨论。

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	尚士洁
	陈大卫
	安翠
	王瑞阳
	吴萌
	于金明

关键词 ：肺癌/放射治疗, 肺癌/免疫治疗, 放疗联合免疫治疗

Abstract：In recent years, immunotherapy has become the hottest topic in the field of oncology. Both the Keynote189 study and the Keynote407 study have confirmed that progression-free survival is significantly prolonged in patients who have been benefited from immune checkpoint blockades in lung cancer. In an article published in The New England Journal of Medicine in 2012, a case report of radiation abscopal effects caused by immunization combined with conventional radiotherapy has attracted great attention in the field of oncology. The Pacific study, published in 2017, expanded the indications for immunotherapy from advanced to locally-advanced non-small cell lung cancer. The second analysis of Keynote001, published in the Lancet Oncology in the same year, suggested that radiation therapy may mediate the immune memory effects, whereas the mechanism and time window are still unclear. With the publication of PEMBRO-RT study and several pieces of work by our team in recent years, various details of radiotherapy combined with immunotherapy (iRT) have become more mature. In clinical practice, iRT is involved in the full treatment of lung cancer. However, iRT is not a hodgepodge or stew that needs further refinement and sorting. In this article, the principles, efficacy in clinical practice, and exploration of the details of iRT were discussed.

Key words： Lung neoplasms/radiation therapy Lung neoplasms/immunotherapy Radiotherapy combined with immunotherapy

收稿日期: 2020-09-18

基金资助:国家自然科学基金(82172676、82030082、31900649);山东省科学基金(ZR2020LZL016)

通讯作者: 于金明,Email:sdyujinming@163.com;陈大卫,Email:dave0505@yeah.net

引用本文:

尚士洁,陈大卫,安翠等. 肺癌放疗与免疫治疗的实践与展望[J]. 中华放射肿瘤学杂志, 2021, 30(11): 1209-1215.

Shang Shijie,Chen Dawei,An Cui et al. Practice and prospect of radiotherapy and immunotherapy for lung cancer[J]. Chinese Journal of Radiation Oncology, 2021, 30(11): 1209-1215.

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