The improvement in treatment strategies and outcomes in small cell lung cancer (SCLC) has lagged behind other cancers. The addition of immune checkpoint inhibitors (ICIs), durvalumab and atezolizumab, to the platinum-based chemotherapy in frontline setting has improved the survival in extensive stage SCLC, (ES-SCLC), albeit modestly, and is now the new standard of care. Prior to advent of immunotherapy into the therapeutic armamentarium in ES-SCLC, consolidative thoracic radiotherapy (TRT) was associated with improved thoracic control and survival outcomes. In the era of ICIs, the role of TRT is not well defined, chiefly because TRT was not incorporated in any immunotherapy trials, secondly due to concerns regarding the increased risks of pneumonitis, and finally uncertain magnitude of benefit with this combined approach. In principle, radiation can increase in the immunogenicity of tumor and hence the activity of immune checkpoint blockade, thereby increasing efficacy both locally and distantly. Such an approach has been promising in non-small cell lung cancer with ICIs improving outcomes after concurrent chemoradiation, but remains unanswered in ES-SCLC. It is, thus, possible that the modest improvement in survival by addition of ICIs to chemotherapy in ES-SCLC can be further improved by the incorporation of consolidative TRT in selected patients. Several early phase trials and retrospective studies have suggested that such an approach may be feasible and safe. Prospective trials are ongoing to answer whether adding radiation therapy to chemoimmunotherapy will improve outcomes in ES-SCLC.

中文翻译：

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胸部巩固放疗在广泛期小细胞肺癌免疫治疗中的作用。

小细胞肺癌（SCLC）治疗策略和结果的改善落后于其他癌症。在一线铂类化疗中添加免疫检查点抑制剂 (ICIs)、durvalumab 和 atezolizumab，改善了广泛期 SCLC (ES-SCLC) 的生存率，尽管效果不大，但现在已成为新的护理标准。在免疫疗法进入 ES-SCLC 治疗设备之前，胸部巩固放疗 (TRT) 与改善胸部控制和生存结果相关。在 ICI 时代，TRT 的作用尚不明确，主要是因为 TRT 没有纳入任何免疫治疗试验，其次是由于担心肺炎风险增加，最后是这种联合方法的获益程度不确定。原则上，放射可以增加肿瘤的免疫原性，从而增加免疫检查点阻断的活性，从而提高局部和远处的疗效。这种方法在非小细胞肺癌中很有希望，ICI 可以改善同步放化疗后的预后，但在 ES-SCLC 中仍然没有答案。因此，通过在 ES-SCLC 化疗中添加 ICI 所带来的生存率的适度改善可能可以通过在选定的患者中结合巩固性 TRT 来进一步改善。一些早期试验和回顾性研究表明这种方法可能是可行且安全的。前瞻性试验正在进行中，以回答在化学免疫治疗中添加放射治疗是否会改善 ES-SCLC 的预后。