在接受免疫治疗的广泛期小细胞肺癌患者中使用放射治疗：加拿大共识建议

SCI

18 March 2023

Use of Radiation Therapy among Patients with Extensive-stage Small-cell Lung Cancer receiving Immunotherapy: Canadian Consensus Recommendations 

(Lung Cancer, IF: 6.081)

Alexander Sun, Bassam Abdulkarim, Normand Blais, Jonathan Greenland,

Alexander V. Louie, Barbara Melosky, Devin Schellenberg, Stephanie Snow,

Geoffrey Liu

CORRESPONDENCE TO: Alex.Sun@rmp.uhn.ca

Objectives 目标  

Thoracic radiation therapy (TRT) and prophylactic cranial irradiation (PCI) are commonly used in the management of extensive-stage small-cell lung cancer (ES-SCLC); however, Phase III trials of first-line immunotherapy often excluded these options. Guidance is needed regarding appropriate use of TRT, PCI, and magnetic resonance imaging (MRI) surveillance while new data are awaited.

胸部放射治疗（TRT）和预防性头颅照射（PCI）通常用于广泛期小细胞肺癌（ES-SCLC）的治疗；然而，一线免疫治疗的III期临床试验往往排除了这些选择。在等待新的试验数据公布时，需要就正确使用TRT，PCI和磁共振成像（MRI）监测疾病发展提供指南。

Materials and Methods 材料和方法  

In two web-based meetings, a pan-Canadian expert working group of five radiation oncologists and four medical oncologists addressed eight clinical questions regarding use of radiation therapy (RT) and MRI surveillance among patients with ES-SCLC receiving immunotherapy. A targeted literature review was conducted using PubMed and conference proceedings to identify recent (January 2019–April 2022) publications in this setting. Fifteen recommendations were developed; online voting was conducted to gauge agreement with each recommendation.

在两次网络会议中，由五名放射肿瘤学家和四名医学肿瘤学家组成的泛加拿大专家工作组讨论了接受免疫治疗的ES-SCLC患者使用放射治疗（RT）和MRI监测的八个临床问题。使用PubMed和会议记录，针对这类情形下2019年1月至2022年4月间发表的最新文章进行文献综述。制定了十五项建议；进行在线投票以评估与每项建议的一致性。

Results 结果  

After considering recently available evidence across lung cancer populations and clinical experience, the experts recommended that all patients with a response to chemo- immunotherapy, good performance status (PS), and limited metastases be considered for consolidation TRT (e.g., 30 Gy in 10 fractions). When considered appropriate after multidisciplinary team discussion, TRT can be initiated during maintenance immunotherapy. All patients who respond to concurrent chemo-immunotherapy should undergo restaging with brain MRI to guide decision-making regarding PCI versus MRI surveillance alone. MRI surveillance should be conducted for two years after response to initial therapy. PCI (e.g., 25 Gy in 10 fractions or 20 Gy in 5 fractions) can be considered for patients without central nervous system involvement who have a response to chemo-immunotherapy and good PS. Concurrent treatment with PCI and immunotherapy or with TRT, PCI, and immunotherapy is appropriate after completion of initial therapy. All recommendations were agreed upon unanimously.

在考虑了最近在肺癌人群和临床经验中可获得的证据后，专家建议所有对化疗免疫治疗有反应，良好体能状态（PS）和有限转移的患者都应考虑巩固TRT（例如，10个部分中的30Gy）。在多学科小组讨论后认为可以在合适时启动维持免疫治疗期间的TRT。所有对同步化疗免疫治疗有反应的患者都应接受脑MRI再分期，以指导PCI与MRI监测决策。对初始治疗有反应的患者应进行两年的MRI监测。对于没有中枢神经系统受累的患者但对化学免疫疗法有反应且有良好的PS评分，可以考虑PCI（例如，10次共25Gy或5次共20Gy）。在完成初始治疗后同时接受PCI和免疫疗法或TRT，PCI和免疫疗法的治疗方式是适当的。所有建议均获得一致同意。

Conclusions 结论  

These consensus recommendations provide practical guidance regarding appropriate use of RT and immunotherapy in ES-SCLC while awaiting new clinical trial data. 

这些共识建议，为在等待新的临床试验数据时期，对ES-SCLC患者的治疗中适当使用RT和免疫疗法提供了实用指导。