目的：胸部放射治疗（TRT）和预防性颅骨照射（PCI）通常用于广泛期小细胞肺癌（ES-SCLC）的治疗；然而，一线免疫疗法的III期试验通常排除这些选择。需要有关适当使用TRT的指导，PCI和磁共振成像（MRI）监测，同时等待新的数据。
方法：在两个基于Web的会议中，一个由5名放射肿瘤学家和4名医学肿瘤学家组成的泛加拿大专家工作组讨论了在接受免疫治疗的ES-SCLC患者中有关放射治疗(RT)使用和MRI监测的8个临床问题.使用PubMed和会议记录进行了有针对性的文献综述，以确定此设置中最近（2019年1月至2022年4月）的出版物。提出了15项建议；进行了在线投票，以评估与每项建议的一致性。
结果：在考虑了肺癌人群和临床经验的最新证据后，专家建议所有对化学免疫疗法有反应的患者，良好的性能状态（PS），和有限的转移被认为是巩固TRT(例如，30Gy的10个部分)。在多学科小组讨论后认为适当时，TRT可以在维持免疫疗法期间开始。所有对同步化学免疫疗法有反应的患者都应进行脑MRI重新分组，以指导有关PCI与单独MRI监测的决策。MRI监测应在对初始治疗有反应后进行两年。PCI(例如，10个部分中的25Gy或5个部分中的20Gy）可以考虑用于对化学免疫疗法和良好PS没有中枢神经系统参与的患者。PCI和免疫治疗或TRT的同时治疗，PCI和免疫疗法在初始治疗完成后是合适的。所有建议都得到了一致同意。
结论：这些共识建议为在ES-SCLC中适当使用RT和免疫治疗提供了实际指导，同时等待新的临床试验数据。
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.
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.
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.
These
consensus recommendations provide practical guidance regarding appropriate use of RT and immunotherapy in ES-SCLC while awaiting new clinical trial data.
