Accelerated Hypofractionated Radiotherapy for Locally Advanced NSCLC: A Systematic Review From the International Association for the Study of Lung Cancer Advanced Radiation Technology Subcommittee.

Nevertheless, there is sparse prospective evidence supporting routine use of accelerated hypofractionation with or without concurrent chemotherapy.

然而，支持加速超分割放疗（无论是否联合化疗）常规使用的前瞻性证据仍然稀缺。

For this reason, the International Association for the Study of Lung Cancer Advanced Radiation Technology Subcommittee conducted a systematic reviewof prospective studies of accelerated hypofractionation for locally advanced NSCLC.

因此，国际肺癌研究协会高级放射技术分委会对加速低分割放疗用于局部晚期非小细胞肺癌的前瞻性研究进行了系统评价。

Methods

A systematic search was conducted on Ovid MEDLINE, Ovid EMBASE, Wiley Cochrane Library, and ClinicalTrials.gov for English publications from 2010 to 2024 for prospective clinical trials and registries investigating accelerated hypofractionated radiotherapy defined as more than 2 Gy delivered in 10 to 25 fractions for nonmetastatic locally advanced (stage III) NSCLC.

在Ovid MEDLINE、Ovid EMBASE、Wiley Cochrane图书馆和ClinicalTrials.gov上进行了系统检索，以查找2010年至2024年间发表的英文文献，这些文献涉及前瞻性临床试验和登记研究，研究对象为非转移性局部晚期（III期）非小细胞肺癌，采用加速低分割放射治疗，定义为每次剂量超过2 Gy，共10至25次分割。

Results

There were 33 prospective studies identified that met the criteria for inclusion.

共识别出33项符合纳入标准的前瞻性研究。

Of 14 prospective studies evaluating definitive accelerated hypofractionation (without concurrent chemotherapy), there were six prospective registries, seven phase 1 to 2 trials, and one phase 3 randomized clinical trial, with a median dose of 60 Gy delivered in a median of 16 fractions, median progression-free survivalof 6.4 to 25 months, median survival of 6 to 34 months, and 0% to 8% severe grade ≥3 esophagitis.

在评估确定性加速低分割放疗（无同步化疗）的14项前瞻性研究中，有六项前瞻性注册研究、七项1至2期试验和一项3期随机临床试验，中位剂量为60 Gy，中位分割次数为16次，中位无进展生存期为6.4至25个月，中位总生存期为6至34个月，严重3级或以上食管炎的发生率为0%至8%。

There were 19 studies evaluating accelerated hypofractionated chemoradiation with platinum doublet-based chemotherapy as the most common concurrent regimen.

共有19项研究评估了以铂类双药为基础的化疗同步加速超分割放疗方案。

Of these accelerated hypofractionated chemoradiation studies, there were 18 phase 1 to 2 trials and one prospective registry with a median radiation dose of 61.6 Gy delivered in a median of 23 fractions, median progression-free survivalof 10 to 25 months, median survival of 13 to 38 months, grade ≥3 esophagitis of 0% to 23.5%, and grade ≥3 pneumonitis of 0% to 11.8%.

在这些加速超分割放化疗研究中，有18项为1至2期试验，一项为前瞻性登记研究，中位放射剂量为61.6 Gy，分23次照射，中位无进展生存期为10至25个月，中位总生存期为13至38个月，3级或以上食管炎发生率为0%至23.5%，3级或以上肺炎发生率为0%至11.8%。

Conclusions

Despite the increasing use of accelerated hypofractionation for locally advanced NSCLC, the supporting randomized evidence remains sparse.

尽管加速低分割放疗在局部晚期非小细胞肺癌中的使用日益增加，但支持的随机证据仍然稀缺。

Only one randomized clinical trial comparing 60 Gy in 15 fractions with 60 Gy in 30 fractions without concurrent chemotherapy did not reveal the superiority of accelerated hypofractionation.

仅有一项随机临床试验比较了60 Gy/15次与60 Gy/30次分割，且未联合化疗，结果并未显示出加速低分割放疗的优越性。

Therefore, the use of accelerated hypofractionated radiotherapy should be approached with caution, using advanced radiation techniques, especially with concurrent chemotherapy or targeted agents.

因此，应谨慎使用加速超分割放射治疗，特别是在同时使用化疗或靶向药物时，应采用先进的放射技术。

Accelerated hypofractionated radiotherapy should be carefully considered alongside other multidisciplinary options and be further investigated through prospective clinical trials.

加速超分割放射治疗应与其他多学科治疗方案一起仔细考虑，并通过前瞻性临床试验进一步研究。