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International consensus on radiotherapy in metastatic non-small cell lung cancer

Authors
Zhu, ZhengfeiNi, JianjiaoCai, XuweiSu, ShengfaZhuang, HongqingYang, ZhenzhouChen, MingMa, ShenglinXie, ConghuaXu, YapingLi, JianchengGe, HongLiu, AnwenZhao, LujunRao, ChuangzhouXie, CongyingBi, NanHui, ZhouguangZhu, GuangyingYuan, ZhiyongWang, JunZhao, LinaZhou, WeiRim, Chai HongNavarro-Martin, ArturoVanneste, Ben G. L.De Ruysscher, DirkChoi, J. IsabelleJassem, JacekChang, Joe Y.Kepka, LucynaKasmann, LukasMilano, Michael T.Van Houtte, PaulSuwinski, RafalTraverso, AlbertoDoi, HiroshiSuh, Yang-GunNoel, GeorgesTomita, NatsuoKowalchuk, Roman O.Sio, Terence T.Li, BaoshengLu, BingFu, Xiaolong
Issue Date
Sep-2022
Publisher
Society for Translational Medicine (STM)
Keywords
Non-small cell lung cancer; radiotherapy; oligo-metastasis; brain metastasis; immune checkpoint inhibitor
Citation
Translational Lung Cancer Research, v.11, no.9, pp 1763 - 1795
Pages
33
Indexed
SCIE
SCOPUS
Journal Title
Translational Lung Cancer Research
Volume
11
Number
9
Start Page
1763
End Page
1795
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/61599
DOI
10.21037/tlcr-22-644
ISSN
2218-6751
2226-4477
Abstract
Background: Lung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) accounting for most cases. While radiotherapy has historically served as a palliative modality in metastatic NSCLC, considerable advances in its technology and the continuous development of cutting-edge therapeutic agents, such as targeted therapy and immune checkpoint inhibitors (ICIs), are increasing its role in the multi-disciplinary management of the disease. Methods: International radiotherapy experts were convened to consider and reach consensuses on the clinical utilities of radiotherapy in metastatic NSCLC, with the aim to provide patient-focused, up to date, evidence-based, recommendations to assist cancer specialists in the management of patients with metastatic NSCLC worldwide. Results: Timely radiotherapy can offer rapid symptom alleviation and allow subsequent aggressive treatment approaches in patients with heavy tumor burden and/or oncologic emergencies. In addition, appropriate incorporation of radiotherapy as concurrent, consolidation, or salvage therapy makes it possible to achieve long-term survival, or even cure, for patients with oligo-metastatic disease. Cranial radiotherapy plays an important role in the management of brain metastasis, potentially augmenting the response and prolonging survival associated with targeted agents and ICIs. However, key questions remain, such as the appropriate choice of radiation techniques, optimal sequence of systemic therapies and radiotherapy, and optimal patient selection for such combination strategies. Although a strong rationale for combining radiotherapy and ICIs exists, its optimal parameters in this setting remain to be established. Conclusions: In the modern era, radiotherapy serves not only as a palliative tool in metastatic NSCLC, but also plays active roles in patients with oligo-focal disease, CNS metastasis and receiving ICIs.
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