Background:Concurrent chemoradiotherapy (CRT) followed by immunotherapy is a standard treatment for locally advanced non-small cell lung cancer (LA-NSCLC), yet many patients are ineligible due to treatment-related toxicity or poor functional status. Chemotherapy-free approaches using radiotherapy (RT) and immunotherapy may offer a safer and equally effective alternative in select patient populations.Methods:A comprehensive literature review was conducted using PubMed, Google Scholar, and relevant conference proceedings focusing on trials between 2000 and 2024. Studies investigating chemotherapy-free regimens combining RT and immunotherapy in LA-NSCLC were analyzed, with emphasis on clinical outcomes, biomarker use, treatment sequencing, radiation dose/fractionation, and safety.Results:Multiple Phase I/II trials reported promising efficacy with one-year progression-free survival (PFS) ranging from 39% to 76%. Toxicity was generally acceptable, though higher-grade adverse events were more frequent in older, frail populations. Trials integrating PD-L1 expression, tumor mutational burden (TMB), and circulating tumor DNA (ctDNA) showed potential for improved patient stratification. Variation in immunotherapy timing (induction, concurrent, or consolidation) and radiation schedules highlight the need for optimization.Conclusions:Chemotherapy-free regimens represent a promising treatment strategy for patients with LA-NSCLC, especially those that are ineligible for standard CRT. Biomarker-driven patient selection and the rational integration of RT and immunotherapy are critical to improving outcomes. Randomized trials are warranted to establish the efficacy and safety of these emerging approaches.
背景：同步放化疗联合免疫治疗是局部晚期非小细胞肺癌的标准治疗方案，但许多患者因治疗相关毒性或功能状态不佳而无法耐受。在特定患者群体中，采用单纯放疗联合免疫治疗的无化疗方案可能提供一种更安全且同样有效的替代选择。 方法：通过PubMed、Google Scholar及相关学术会议资料库，对2000年至2024年间发表的文献进行全面综述。重点分析局部晚期非小细胞肺癌中放疗联合免疫治疗的无化疗方案相关研究，聚焦临床结局、生物标志物应用、治疗时序、放疗剂量/分割模式及安全性。 结果：多项I/II期试验显示该方案具有良好疗效，一年无进展生存率达39%至76%。总体毒性可接受，但在高龄体弱患者中高级别不良事件发生率较高。整合PD-L1表达、肿瘤突变负荷及循环肿瘤DNA检测的研究显示出优化患者分层的潜力。免疫治疗时机（诱导、同步或巩固）与放疗方案的差异凸显了治疗方案需进一步优化。 结论：无化疗方案为局部晚期非小细胞肺癌患者，尤其是不适合标准同步放化疗的患者，提供了具有前景的治疗策略。基于生物标志物的患者筛选以及放疗与免疫治疗的合理整合是改善疗效的关键。未来需要开展随机对照试验以确证这些新兴方案的疗效与安全性。
肿瘤(癌症)患者之家