非小细胞肺癌免疫治疗联合立体定向放疗的 研究进展与挑战
Research Progress and Challenges of Immunotherapy Combined with Stereotactic Body Radiotherapy for Non-Small Cell Lung Cancer
DOI: 10.12677/acm.2026.1652142, PDF,   
作者: 徐佳欢：西安医学院研究生院，陕西 西安；陕西省人民医院放疗科，陕西 西安；杨诗瑞：陕西省人民医院放疗科，陕西 西安；延安大学延安医学院，陕西 延安；党运芝*：陕西省人民医院放疗科，陕西 西安
关键词: 非小细胞肺癌；免疫检查点抑制剂；立体定向消融放疗；协同作用；远隔效应；Non-Small Cell Lung Cancer； Immune Checkpoint Inhibitors； Stereotactic Body Radiotherapy； Synergistic Impact； Abscopal Influence
摘要: 非小细胞肺癌(NSCLC)是世界范围内主要的癌症致死原因之一。近些年免疫检查点抑制剂(ICIs)与立体定向消融放疗(SBRT)的迅速进步，完全改变NSCLC的治疗局面。尽管单药免疫治疗或者单纯SBRT于特定患者里可明显改善预后，但是单一疗法的效果仍然存在瓶颈。逐渐增多的证据显示，ICIs和SBRT的联合运用具备明显的协同效果：SBRT不但能够提高局部控制率，还可基于原位疫苗效应激活全身性的抗肿瘤免疫反应，进一步控制远处的微小转移病灶。本文意在全面梳理NSCLC免疫疗法联合SBRT的生物学原理、临床研究的最新动态、所面临的主要难题以及未来的发展走向。文章会深度研究SBRT怎样基于重塑肿瘤免疫微环境提高ICIs疗效，同时归纳现有的主要临床试验数据。最终围绕联合治疗里的毒性管控、最优联合策略以及耐药机理等主要问题展开分析，期望能为临床供给更优质的治疗方案。
Abstract: Non-Small cell lung cancer (NSCLC) is a primary reason for cancer-related death worldwide. Recently, immune checkpoint inhibitors (ICIs) and stereotactic body radiotherapy (SBRT) have become important treatment approaches, resulting in clinical survival advantages. Even though single-agent immunotherapy or SBRT used separately can enhance clinical results in certain NSCLC patients, the effectiveness of monotherapy still shows evident limitations in clinical settings. An increasing amount of evidence has shown that the joint use of ICIs and SBRT can produce a significant synergistic impact: SBRT not only enhances the local tumor control ratio, but also initiates a systemic anti-tumor immune reaction via the in situ vaccine effect, thereby attaining effective management of distant micrometastatic lesions. This paper intends to comprehensively examine the biological mechanisms behind the combination of ICI-based immunotherapy and SBRT for NSCLC. It also covers the most recent progress in relevant clinical research, the main challenges in clinical application, and the future research orientations. We will thoroughly investigate how SBRT improves the therapeutic effect of ICIs through reshaping the tumor immune micro-environment, and sum up the accessible data from crucial clinical trials in this area. Finally, we examine the key issues including toxicity management, optimal combination approach, and drug resistance mechanism in the combined treatment, aiming to offer more optimized treatment plans for clinical practice.
文章引用：徐佳欢, 杨诗瑞, 党运芝. 非小细胞肺癌免疫治疗联合立体定向放疗的 研究进展与挑战[J]. 临床医学进展, 2026, 16(5): 3227-3236. https://doi.org/10.12677/acm.2026.1652142

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