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

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.

Radiation induced therapeutic effects in cancerous and tumor cells: A review

“…There are two types of lung cancer: non-small cell lung cancer (metastatic NSCLC) and small cell lung cancer. 58 Lung cancer has higher morbidity and mortality than most cancers. 59 SLC solely responsible for 10-15% of all lung cancers and yes, the prognosis is very poor.…”

A retrospective analysis of optimal timing of thoracic radiotherapy for driver gene‐negative metastatic non‐small cell lung cancer

“…A meta‐analysis found that addition of radiotherapy to the primary tumor could significantly improve the OS and PFS of patients with oligometastatic NSCLC 10 . In another study, radiotherapy for thoracic diseases resulted in a significant reduction in the risk of death by 56% and in the risk of disease progression by 58%, respectively 11 . Hence, the addition of radiotherapy directed at the primary tumor could confer survival benefits in a selected group of patients with mNSCLC.…”

“…To date, there has been no evidence from randomized clinical trials supporting which timing is better for survival when integrating TRT into the comprehensive treatment of mNSCLC 11 . A previous retrospective study has indicated that EGFR‐TKI plus earlier TRT (receiving radiotherapy before EGFR‐TKI resistance) achieved better PFS compared with delayed TRT (receiving radiotherapy after progressive disease) in stage IV EGFR ‐mutant NSCLC patients and a lower incidence of radiation pneumonitis 12 .…”

Palliative extracranial radiotherapy in patients receiving immunotherapy for non-small cell lung cancer: a narrative review

“…This was extensively discussed in a recent consensus of international experts on the use of RT in metastatic NSCLC. However, this was agreed that the evidences on the impact of RT on survival come from the trials in which IO was not used (10). Thus still being aware of the impact of IO on survival in metastatic NSCLC, we cannot yet consider these cases as curable.…”