放疗联合免疫检查点抑制剂治疗非小细胞肺癌研究进展

肺癌是世界上常见的致死性癌症之一,其中85%的肺癌为非小细胞肺癌(non-small cell lung cancer,NSCLC)。目前放疗是NSCLC主要的治疗手段之一。随着免疫治疗的发展,免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)已成为部分晚期NSCLC患者的一线治疗。研究发现放疗与免疫治疗具有协同效应,能够改善NSCLC患者的生存。众多研究探索了放疗联合ICIs治疗NSCLC的安全性及有效性,本文就放疗联合ICIs治疗NSCLC的研究进展做一综述。

The role of stereotactic body radiotherapy in hepatocellular carcinoma:guidelines and evidences

Hepatocellular carcinoma(HCC)is a common malignancy with high mortality rates.While surgery can be curative in early-stage disease,80% of patients cannot undergo surgical resection.Stereotactic body radiotherapy(SBRT),an emerging,non-invasive,precision treatment,has shown promising results across various stages of HCC and has thus been adopted in practice to varying degrees around the world.This article aims to review current guideline recommendations on SBRT,clinical evidence,and outcome comparisons with other local treatment modalities.Attempts are also made to compare the differences in clinical trials between Asian and Western countries.

Significance of radiation esophagitis:Conditional survival assessment in patients with non-small cell lung cancer

Purpose:This study aimed to examine the effect of radiation esophagitis(RE)and the dynamics of RE on subse-quent survival in non-small cell lung cancer(NSCLC)patients who underwent radiotherapy.Experimental Design:Patients with NSCLC treated with fractionated thoracic radiotherapy enrolled in prospective trials were eligible.RE was graded prospectively according to Common Terminology Criteria for Adverse Events(CTCAE)v3.0 per protocol requirement weekly during-RT and 1 month after RT.This study applied conditional survival assessment which has advantage over traditional survival analysis as it assesses the survival from the event instead of from the baseline.P-value less than 0.05 was considered to be significant.The primary endpoint is overall survival.Results:A total of 177 patients were eligible,with a median follow-up of 5 years.The presence of RE,the maximum RE grade,the evolution of RE and the onset timing of RE events were all correlated with subsequent survival.At all conditional time points,patients first presented with RE grade1(initial RE1)had significant inferior subsequent survival(multivariable HRs median:1.63,all P-values<0.05);meanwhile those with RE progressed had significant inferior subsequent survival than those never develop RE(multivariable HRs median:2.08,all P-values<0.05).Multivariable Cox proportional-hazards analysis showed significantly higher C-indexes for models with inclusion of RE events than those without(all P-values<0.05).Conclusion:This study comprehensively evaluated the impact of RE with conditional survival assessment and demonstrated that RE is associated with inferior survival in NSCLC patients treated with RT.

Precision radiation therapy in the modern era of multidisciplinary care in oncology:What matters to our patients and beyond?

The current standard of cancer care is combined multimodality ther-apy,including surgery,radiation therapy,chemotherapy,target ther-apy,and immune therapy.Radiation therapy,as one of these five major cancer modalities,has a significant contribution to the cure of cancer patients.According to the 2006 data of the Surveillance,Epidemiology,and End Results(SEER)Program,an estimated 3.05 million cancer sur-vivors received radiation therapy,accounting for 29%of all 5-year can-cer survivors.1 The number of radiation-treated cancer survivors is pro-jected to 4.17 million by 2030.The radiation-treated female survivors were at 58%and projected to increase to 66%in 2030.1 It was estimated that about 50%of cancer patients in developed countries such as Aus-tralia indicated for radiation therapy,2,3 while less than 10%patients in low-income countries had access to such a life-saving treatment.4,5 Interestingly,the availability of radiation therapy has direct correlation with the survival of the cancer patients 6 or the mortality to incidence ra-tio(MIR)of cancer.7 The high-income countries have lower MIRs than many low/middle income countries where over 50%and 90%of pa-tients requiring radiotherapy do not have access to this life saving treat-ment.7 While the reason of such discrepancy is multifactorial,limited knowledge on the role of radiation therapy is an important reason.In-vesting in radiation therapy was associated with more life-saving and economic benefit,as presented in a special issue in Lancet Oncology.8 This highlights the importance of promoting the data and evidence in radiation therapy,justifying this very first special issue of the Journal of the National Cancer Center(JNCC)to promote the research and clinical activity on the role of radiation therapy.