放疗与免疫治疗在恶性肿瘤治疗中的相互作用

The Interaction between Radiotherapy and Immunotherapy in the Treatment of Ma-lignant Tumors

摘要: 大部分被诊断为恶性肿瘤的患者将在病程中接受放疗，在以治疗或缓解病痛为目的的传统上，以往放射治疗的有效性仅被解释为治疗体积内针对肿瘤细胞DNA的不可修复性损伤，导致细胞死亡或丧失复制潜能。在过去的几年里，免疫检查点抑制剂的出现，改变了很多恶性肿瘤的治疗现状，为抗肿瘤治疗提供了新的努力方向和希望。然而，越来越多的数据表明，免疫系统也是放疗反应的关键性决定因素，放射和免疫联合治疗可能是协同作用。这种联合可能提供一种非药理学、低毒性和较经济的方法来增加全身反应和最大限度地增加肿瘤细胞的死亡。该综述主要基于免疫时代的到来改变了恶性肿瘤治疗模式、放疗与免疫治疗联合的理论机制，及在联合治疗过程中需要关注的问题展开，并提出了对联合方案的优化，并对未来将面临的挑战和发展方向提出总结与展望。

Abstract: Most patients diagnosed with malignant tumors will receive radiation therapy during the course of the disease. Traditionally, the effectiveness of radiation therapy was only explained as irreparable damage to tumor cell DNA within the treatment volume, leading to cell death or loss of replication potential, with the aim of treating or alleviating pain. In the past few years, the emergence of im-mune checkpoint inhibitors has changed the current treatment status of many malignant tumors, providing new directions and hope for anti-tumor treatment. However, an increasing amount of da-ta suggests that the immune system is also a key determinant of radiation response, and the com-bination of radiation and immune therapy may be a synergistic effect. This combination may pro-vide a non pharmacological, low toxicity, and more economical method to increase systemic reac-tions and maximize tumor cell death. This review is mainly based on the arrival of the immune era, which has changed the treatment mode of malignant tumors, the theoretical mechanism of the combination of radiotherapy and immunotherapy, and the issues that need to be paid attention to during the combined treatment process. It also proposes the optimization of the combined plan, and summarizes and prospects the challenges and development directions that will be faced in the future.