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.
姑息性胸部放疗可为约三分之二的非小细胞肺癌患者提供快速有效的症状缓解。对于体能状态较差的患者，姑息效果似乎与放疗剂量或分割方案无关。相反，对于体能状态良好的患者，较长时间内给予较高放疗剂量已显示出适度的生存获益。这些发现源于免疫治疗和靶向治疗应用于临床实践之前的研究。目前，在这一新的治疗时代，尚未有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，并越来越多地用于特定患者的姑息治疗，这反映了转移性非小细胞肺癌治疗选择的扩展和预后的改善。姑息性胸部放疗的一些传统原则，例如通过延长放疗计划改善总生存期，以及使用简单、经济有效的放疗技术进行姑息治疗，对于接受免疫治疗或靶向治疗的患者可能不再适用。调强放疗或立体定向放疗在非小细胞肺癌姑息性放疗中的应用尚未得到充分探索，本综述将对此进行探讨。此外，姑息性放疗与这些全身治疗联合应用所带来的新风险正在探索中，并在姑息治疗的背景下进行讨论。放疗与免疫治疗或靶向治疗联合应用的最佳时机、剂量、分割方案和治疗范围目前仍是研究课题。在紧急情况下，放疗应作为挽救生命的措施立即使用。然而，对于姑息性胸部放疗的其他适应症，关于剂量、与全身治疗相关的时机以及治疗范围的决策应在多学科背景下，综合考虑患者的预后、预期结果以及获得潜在有效治疗的机会来制定。我们在这方面仍缺乏来自前瞻性研究的可靠数据。本综述在现代非小细胞肺癌治疗策略的框架内，审视并讨论了关于姑息性胸部放疗应用的现有证据。
Palliative Thoracic Radiotherapy in the Era of Modern Cancer Care for NSCLC
肿瘤(癌症)患者之家