Data_Sheet_2_Predicting Outcomes From Radical Radiotherapy for Non-small Cell Lung Cancer: A Systematic Review of the Existing Literature.DOCX

Radical radiotherapy (RT) is a potentially curative treatment in non-small cell lung cancer (NSCLC) and is delivered in conventional 2-Gy fractions, hypofractionated and ablative stereotactic courses. No reliable, predictive biomarkers for the clinical events of local control, appearance of distant metastases and development of toxicity have been introduced in routine clinical practice. Such a test would enable the Radiotherapist to tailor the clinical management of individual patients, considering their pre-treatment characteristics, in order reduce the risk of recurrence or toxicity e.g., dose modification, accelerated fractionation, hypofractionation, or concurrent systemic therapy. The aim of this review was to map the published literature relating to investigations of the potential predictive value of patient or treatment characteristics in radical RT for NSCLC. These investigations should remain a research focus for disease control given the upward trends in lung cancer incidence, and for the avoidance of toxicity, given the survivorship afforded to the cohort of patients that do well with radical RT, or with the increasing range of systemic agents following metastatic relapse. The conclusion of the presented analysis is that there are no published, effective and validated predictive tools for estimation of risk of local/distant recurrence or toxicity after radical RT for NSCLC. The authors have identified an important space for future research in the field of lung cancer radiotherapy.

根治性放射治疗（radical radiotherapy, RT）是非小细胞肺癌（non-small cell lung cancer, NSCLC）的潜在治愈性治疗手段，其实施方式包括常规2Gy分割、大分割以及消融性立体定向放疗疗程。目前临床常规实践中，尚未有针对局部控制、远处转移发生及毒性反应发生这些临床结局的可靠预测生物标志物（biomarker）投入应用。这类检测可让放射治疗医师结合患者的治疗前特征，为其定制个体化临床管理方案，从而降低复发或毒性反应风险，例如调整剂量、加速分割放疗、大分割放疗或同步全身治疗。本综述的目的是系统梳理已发表的相关文献，这些文献围绕非小细胞肺癌根治性放射治疗中患者特征或治疗特征的潜在预测价值展开研究。鉴于肺癌发病率呈上升趋势，且接受根治性放疗后预后良好的患者群体可获得长期生存，同时转移性复发后可用的全身治疗手段日益增多，因此这类研究应继续作为疾病控制与毒性规避领域的研究重点。本次分析的结论为，目前尚无已发表的、经有效验证的预测工具，用于评估非小细胞肺癌根治性放疗后局部/远处复发或毒性反应的发生风险。本研究团队明确了肺癌放射治疗领域未来值得探索的重要研究方向。