| 王煜聪,胡松柳.免疫治疗时代广泛期小细胞肺癌胸部巩固放疗的临床意义[J].肿瘤学杂志,2026,32(3):199-207. |
| 免疫治疗时代广泛期小细胞肺癌胸部巩固放疗的临床意义 |
| Consolidative Thoracic Radiotherapy for Extensive Stage Small Cell Lung Cancer in the Immunotherapy Era： Current Evidence and Clinical Implications |
| 投稿时间：2025-05-26 |
| DOI：10.11735/j.issn.1671-170X.2026.03.B004 |
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| 中文关键词: 小细胞肺癌 广泛期 放射疗法 免疫治疗 靶区勾画 预防性脑照射 |
| 英文关键词:small cell lung cancer extensive stage radiotherapy immunotherapy target volume contouring prophylactic cranial irradiation |
| 基金项目: |
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| 摘要点击次数: 26 |
| 全文下载次数: 10 |
| 中文摘要: |
| 摘 要：免疫检查点抑制剂联合化疗已成为广泛期小细胞肺癌（extensive stage small cell lung cancer，ES-SCLC）的一线标准治疗，显著改善了患者生存，但胸内病灶复发仍是主要挑战。免疫治疗前时代的研究已证实胸部巩固放疗对化疗敏感的ES-SCLC患者的局部控制及生存有益。然而，在免疫治疗时代胸部巩固放疗确切疗效、安全性、最佳剂量分割模式、介入时机及靶区勾画原则仍需前瞻性证据支持。同时，免疫治疗对脑转移的活性使预防性脑照射的临床价值面临重新评估。全文系统探讨免疫治疗时代ES-SCLC患者接受胸部巩固放疗的临床价值、剂量分割方式、最佳介入时机及靶区勾画原则，并分析预防性脑照射在当前综合治疗模式中的可行性与临床获益，旨在为优化ES-SCLC多学科联合治疗方案提供理论依据。 |
| 英文摘要: |
| Abstract： Immune checkpoint inhibitors(ICIs) combined with chemotherapy have become the first-line standard of care for extensive stage small cell lung cancer (ES-SCLC)， significantly improving patient survival. However， intrathoracic recurrence persists as a major cause of treatment failure. While consolidative thoracic radiotherapy (cTRT) has demonstrated benefits for local control and survival in chemo-sensitive ES-SCLC in the pre-immunotherapy era， its definitive role within contemporary chemoimmunotherapy regimens requires further elucidation. Key unresolved questions pertain to the optimal efficacy， safety profile， dose fractionation， timing， and target volume delineation for cTRT in this new context. Furthermore， the activity of ICIs against brain metastases prompts a critical re-evaluation of the role of prophylactic cranial irradiation (PCI). This review systematically explores the current evidence， clinical rationale， and practical considerations for cTRT in ES-SCLC patients treated with chemoimmunotherapy， including discussions on dose optimization， integration timing， and evolving contouring principles. It also analyzes the evolving landscape and ongoing debates regarding PCI. The aim is to synthesize existing knowledge and highlight future directions to guide the optimization of multidisciplinary management for ES-SCLC in the immunotherapy era. |
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