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

Zhengfei Zhu, Jianjiao Ni, Xuwei Cai, Shengfa Su, Hongqing Zhuang, Zhenzhou Yang, Ming Chen, Shenglin Ma, Conghua Xie, Yaping Xu, Jiancheng Li, Hong Ge, Anwen Liu, Lujun Zhao, Chuangzhou Rao, Congying Xie, Nan Bi, Zhouguang Hui, Guangying Zhu, Zhiyong YuanJun Wang, Lina Zhao, Wei Zhou, Chai Hong Rim, Arturo Navarro-Martin, Ben G L Vanneste, Dirk De Ruysscher, J Isabelle Choi, Jacek Jassem, Joe Y Chang, Lucyna Kepka, Lukas Käsmann, Michael T Milano, Paul Van Houtte, Rafal Suwinski, Alberto Traverso, Hiroshi Doi, Yang-Gun Suh, Georges Noël, Natsuo Tomita, Roman O Kowalchuk, Terence T Sio, Baosheng Li, Bing Lu, Xiaolong Fu

Research output: Contribution to journalReview articleAcademicpeer-review

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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.

Original languageEnglish
Pages (from-to)1763-1795
Number of pages33
JournalTranslational Lung Cancer Research
Issue number9
Publication statusPublished - Sept 2022
Externally publishedYes

Bibliographical note

Funding Information:
Center) and Tiantian Guo (Fudan University Shanghai Cancer Center) for data collecting and manuscript drafting. Finally, we thank Jinming Yu (Shandong Cancer Hospital Affiliated to Shandong University), Lvhua Wang (Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College) and Ping Wang (Tianjin Medical University Cancer Institute and Hospital) for their guidance and kindly support in this project. The authors also appreciate the academic support from the AME Lung Cancer Collaborative Group. Funding: The study was supported by the Science and Technology Commission of Shanghai Municipality (Nos. 20Y11913500 and 19411965900) and the Hospital Development Center of Shanghai (No. SHDC2020CR4010).

Funding Information:
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups. com/article/view/10.21037/tlcr-22-644/coif). DDR’s institution received grants from BMS, AstraZeneca, Philips Health, and Beigene. JIC received speaker honoraria from Varian Medical Systems. JYC received research grant from BMS and consulting fees from Legion Healthcare Partners. Lukas Käsmann received honoraria from AMGEN. MTM received a speaker fee from Astra Zeneca and royalties from Wolters Kluwer. HD received research grant from Japan Society for the Promotion of Science and lecture fee from AstraZeneca. TTS provides strategic and scientific recommendations as a member of the Advisory Board and speaker for Novocure, Inc., which is not in any way associated with the content presented in this manuscript. The other authors have no conflicts of interest to declare.

Publisher Copyright:
© 2022 AME Publishing Company. All rights reserved.


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