Definitive Radiotherapy to the Primary Tumor in Stage IV NSCLC: A Consensus Statement From the International Association for the Study of Lung Cancer Advanced Radiation Technology Subcommittee.

This International Association for the Study of Lung Cancer (IASLC) consensus statement evaluates the current evidence for the role, timing, dosing, target volumes, and safety of primary-tumor RT in both actionable genomic alterations (AGA) and non-AGA metastatic NSCLC populations.

国际肺癌研究协会（IASLC）的这份共识声明评估了在可操作基因改变（AGA）和非AGA转移性NSCLC人群中，原发肿瘤放射治疗的作用、时机、剂量、靶区体积和安全性的当前证据。

The IASLC Advanced Radiation Technology subcommittee convened a multidisciplinary, international expert panel including radiation oncologists and medical oncologists from the IASLC Multidisciplinary Clinical Sciences Committee.

IASLC高级放射技术小组委员会召集了一个多学科、国际专家小组，包括来自IASLC多学科临床科学委员会的放射肿瘤科医生和内科肿瘤科医生。

Randomized studies published from 2010 to 2025 evaluating RT to the primary lung tumor in metastatic NSCLC populations (AGA and non-AGA) were identified through PubMed, and relevant published and presented abstracts were included.

通过PubMed识别了2010年至2025年间发表的随机研究，这些研究评估了对转移性非小细胞肺癌（AGA和非AGA）原发性肺肿瘤进行放射治疗的效果，并包括了相关的已发表和已展示的摘要。

Evidence was synthesized and discussed to achieve consensus recommendations.

证据被综合并讨论，以达成共识建议。

In EGFR-mutant oligometastatic NSCLC, randomized phase III evidence supports early delivery of RT, conveyed as consolidation after induction systemic therapy, as a promising life-prolonging approach.

在EGFR突变寡转移性非小细胞肺癌中，随机III期证据支持早期放疗，作为诱导系统治疗后的巩固治疗，作为一种有前景的延长生命的方法。

In non-AGA populations, direct randomized evidence isolating the impact of primary irradiation remains limited.

在非雄激素性脱发（AGA）人群中，直接随机证据隔离主要放射治疗的影响仍然有限。

Emerging randomized data suggest dose escalation of definitive thoracic RT regimens may improve locoregional control compared with lower-dose approaches.

新兴的随机数据表明，与低剂量方法相比，提高确定性胸部放射治疗（RT）方案的剂量可能会改善局部区域控制。

Fractionation should be individualized to the primary tumor location to mitigate cardiopulmonary adverse events.

分割方案应根据原发肿瘤的位置进行个体化调整，以减轻心脏和肺部的不良事件。

Optimal target volumes remain uncertain, and the benefit of excluding involved thoracic lymph nodes has not yet been formally investigated in large, randomized trials.

最佳的靶区体积尚不明确，且在大型随机试验中尚未正式研究排除涉及的胸部淋巴结的益处。

Safety data indicate toxicity is generally additive when RT is integrated with systemic agents; however, careful monitoring and recording of adverse events are important to ensure the addition of RT does not affect systemic therapy discontinuation rates.

安全性数据显示，当放射治疗（RT）与系统性药物联合使用时，毒性通常是相加的；然而，仔细监测和记录不良事件对于确保放射治疗的加入不会影响系统性治疗的停药率至关重要。

Definitive-dose RT to the primary lung tumor in metastatic NSCLC is supported by a growing biologic rationale and emerging trial data, with the strongest evidence in EGFR mutant populations.

对于转移性非小细胞肺癌（NSCLC），将确定剂量的放射治疗（RT）用于原发性肺癌肿瘤得到了越来越多的生物学理论支持和新兴试验数据的支持，其中EGFR突变人群中的证据最为有力。

For patients without AGAs, preliminary findings are encouraging but insufficient for definitive treatment recommendations.

对于没有AGAs的患者，初步发现令人鼓舞，但不足以做出明确的治疗建议。

The paucity of data necessitates prospective trials that isolate the contribution of primary-tumor RT, confirm its safety, and define the optimal RT sequencing, dose, and target volumes.

数据的匮乏需要前瞻性试验来隔离原发肿瘤放疗的贡献，确认其安全性，并定义最佳的放疗序列、剂量和靶区体积。