肺癌放射免疫新实践

New practice of radio-immunotherapy for lung cancer

近年来,放疗联合免疫治疗(iRT)引起了肿瘤学界的强烈关注,目前有数百项关于iRT的大型临床试验在进行。放疗会使肿瘤细胞发生免疫原性死亡,促进肿瘤抗原释放、提呈,激活T细胞;放疗也可以重塑肿瘤微环境,使其从免疫抑制状态转变为免疫激活状态。免疫检查点抑制剂不仅能解除T细胞抑制,而且能使肿瘤血管正常化,从而改善肿瘤微环境缺氧,增加放疗敏感性,这就是放疗与免疫治疗协同抗肿瘤的基本原理。iRT日趋成熟,但也面临着诸多挑战。本文分别回顾免疫治疗和放疗近年来的发展历程,并探讨iRT使用的时机、分割剂量、治疗相关毒性反应等。

In recent years, immunotherapy combined with radiotherapy(iRT) has attracted great attention in the field of oncology, and hundreds of large clinical trials on iRT are currently underway. Radiotherapy can cause immunogenic death of tumor cells, promote the release and presentation of tumor antigens, and activate T cells. Radiotherapy can also reshape the tumor microenvironment from immunosuppression to immune activation. Immune checkpoint inhibitors can not only relieve T cell inhibition but also normalize tumor vessels so as to improve tumor hypoxia and increase radiosensitivity, which is the basic principle of synergistic anti-tumor effect of radiotherapy and immunity. Now iRT is becoming more and more mature, but it also faces many challenges. This paper will review the development of immunotherapy and radiotherapy in recent years, and explore the timing, fractional dose and treatment-related toxicity of iRT.