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作者：SCI天天读
SCI
10 June 2023
Emerging evidence for adapting radiotherapy to immunotherapy
（nature reviews clinical oncology; IF: 65.011）
Lorenzo Galluzzi, Molykutty J. Aryankalayil, C. Norman Coleman & Silvia C. Formenti
CORRESPONDENCE TO: formenti@med.cornell.edu
Immunotherapy has revolutionized the clinical management of many malignancies but is infrequently associated with durable objective responses when used as a standalone treatment approach, calling for the development of combinatorial regimens with superior efficacy and acceptable toxicity. Radiotherapy, the most commonly used oncological treatment, has attracted considerable attention as a combination partner for immunotherapy owing to its well-known and predictable safety profile, widespread clinical availability, and potential for immunostimulatory effects. However, numerous randomized clinical trials investigating radiotherapy–immunotherapy combinations have failed to demonstrate a therapeutic benefit compared with either modality alone. Such a lack of interaction might reflect suboptimal study design, choice of end points and/or administration of radiotherapy according to standard schedules and target volumes. Indeed, radiotherapy has empirically evolved towards radiation doses and fields that enable maximal cancer cell killing with manageable toxicity to healthy tissues, without much consideration of potential radiation-induced immunostimulatory effects. Herein, we propose the concept that successful radiotherapy–immunotherapy combinations might require modifications of standard radiotherapy regimens and target volumes to optimally sustain immune fitness and enhance the antitumour immune response in support of meaningful clinical benefits.
免疫疗法已经彻底改变了许多恶性肿瘤的临床治疗，但作为一种单独的治疗方法，很少有持久的客观反应，这就要求开发有效的和可接受毒性的组合方案。放疗是最常用的肿瘤治疗方法，由于其众所周知的可预测的安全性、广泛的临床应用和潜在的免疫刺激作用，结合免疫治疗，已经引起了相当大的关注。然而，许多研究放疗-免疫治疗组合的随机临床试验未能证明与单独使用任何一种方式相比有治疗益处。这种缺乏互相影响的情况可能反映了研究设计，终点的选择和/或根据时间和目标量进行的放疗的不理想。事实上，放疗在经验上已经发展到能够最大限度地杀死癌细胞并对健康组织有可控毒性的辐射剂量和辐射场，而没有过多考虑潜在的辐射诱导的免疫刺激效应。在此，我们提出这样一个概念：成功的放疗-免疫治疗组合可能需要修改标准的放疗方案和靶向量，以最佳的方式维持免疫力，增强抗肿瘤免疫反应来获取有意义的临床效益。
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原文地址：http://mp.weixin.qq.com/s?src=11×tamp=1686407951&ver=4582&signature=GlspVzNpF8WPjOa*iPn85PHECBQ91dDpu7BAYkQwxFb76lD5ITBkRCnfZmqH9Qk7TaciuH36ilDD8S17qXn9eq7g01OMfjYxZp*DmqxucMP5YEAyWJn80aFboJCmSPbK&new=1 |
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