Data_Sheet_4_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，临床实施方式包括常规2Gy分割放疗、大分割放疗以及消融性立体定向放疗。目前临床常规实践中，尚未有可有效预测局部控制、远处转移发生及毒性反应发生的可靠预测生物标志物。此类检测工具可帮助放疗医师结合患者治疗前的特征制定个体化临床管理策略，以降低复发或毒性反应风险，例如调整照射剂量、加速分割放疗、大分割放疗或同步全身治疗。本综述旨在系统梳理已发表的相关文献，探究非小细胞肺癌根治性放疗中患者特征与治疗特征的潜在预测价值。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生存期得以延长，或是转移性复发后可选择的全身治疗手段日益增多，相关研究仍应作为疾病控制与毒性规避领域的重点研究方向。本次分析的结论为，目前尚无已发表且经过验证的有效预测工具，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。作者团队认为，肺癌放疗领域存在亟待开拓的重要研究空白。