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关于 NSCLC 孤立性骨转移的治疗，目前尚缺乏大样本的前瞻性随机对照临床研究数据。对于 PS 评分为 0~1 分、肺部病变为非 N2 且可完全性切除的患者，多项回顾性研究显示，肺原发病变手术治疗加骨转移病变放射治疗或手术，联合系统全身化疗和双膦酸盐治疗，患者可获益，中位生存可达 8~35 个月［1-6］。对于原发病变分期为Ⅰ~ Ⅱ期的患者，手术的生存获益明显优于Ⅲ期患者［4］。对于承重骨骨转移患者，推荐转移灶手术加放疗，可显著降低神经功能损伤，提高 KPS 评分及患者生存质量［7］。
两项前瞻性随机对照Ⅲ期临床研究结果显示，与安慰剂对比，双膦酸盐能明显降低肺癌骨转移患者的骨相关不良事件发生率，可以和常规抗肿瘤治疗联合使用［8-9］。此外，一项比较地舒单抗和唑来膦酸在预防合并骨转移的晚期肿瘤的随机双盲Ⅲ期研究结果显示，相比唑来膦酸，地舒单抗能够显著延缓首次出现骨相关事件的时间长达 6 个月（21.4 个月 vs. 15.4 个月；HR=0.81；95% CI 0.68~0.96； P=0.017），首次出现骨相关事件的风险降低 19%［10］。一项研究对 NSCLC 骨转移患者的亚组分析结果显示，与唑来膦酸相比，地舒单抗的中位 OS 具有显著优势（9.5 个月 vs. 8.0 个月），死亡风险降低 22%［11］。2020 年 NMPA 已批准地舒单抗用于预防实体瘤骨转移及多发性骨髓瘤引起的骨相关事件，因此地舒单抗成为晚期肺癌骨转移治疗新选择。
对于原发病变能完全切除但由于某些原因无法手术或不愿手术的患者，可考虑原发病变放疗和骨转移病变放疗，联合系统性全身化疗 + 双膦酸盐治疗［12-13］，中位 OS 达到 13.5~23 个月。
对于 PS 评为 0~1 分、肺部病变为 N2 或 T4 的患者，回顾性研究结果显示原发病变行序贯或同步放化疗，骨转移病变放射治疗，联合系统性全身化疗 + 双膦酸盐治疗，患者可获益，中位生存期为13.5~14 个月，1、2、3 年的总生存率分别为 58.1%、24.8%、15.8%［13-14］。
孤立性骨转移 NSCLC 患者的系统性全身治疗方案见指南其他章节中的Ⅳ期患者系统性全身治疗。
⏫ Ⅳ期孤立性转移非小细胞肺癌的治疗
参考指南：
中国临床肿瘤学会指南工作委员会.中国临床肿瘤学会 (CSCO) 非小细胞肺癌诊疗指南2024.人民卫生出版社.北京 2024
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