EGFR-TKIs联合放疗在局部晚期非小细胞肺癌治疗中的地位和作用

不可手术切除的局部晚期非小细胞肺癌（non-small cell lung cancer,NSCLC）从组织分型看,标准治疗模式为同期化放疗,但从分子分型看,表皮生长因子受体（epidermal growth factor receptor,EGFR）外显子19、21突变阳性的NSCLC患者一线应用EGFR酪氨酸激酶抑制剂（EGFR-TKIs）,将在生存上最大程度地获益。放疗具有手术不可比拟的空间和化疗无法取得的局部优势,放疗可激活EGFR信号通路,通过诱导细胞增殖和增强DNA修复而导致放疗抵抗,EGFR-TKIs具有放疗增敏作用。临床研究结果提示EGFR-TKIs联合胸部放疗治疗局部晚期或转移NSCLC患者,总体上毒性反应可以耐受,但生存获益程度不一,可能与病例选择不同有关。对于EGFR基因突变的不可切除的NSCLC患者,EGFR-TKIs同步个体化放疗目前缺乏大样本多中心的临床研究结果,也许是今后一线治疗的一种选择。

The situation and application of EGFR-TKIs combined with radiotherapy in treating local advanced non-small cell lung cancer

The standard treatment for those unresectable regional advanced non-small cell lung cancer（NSCLC） is concurrent chemo-radiotherapy.For those NSCLC patients with epidermal growth factor receptor（EGFR） exons 19,21 positive mutation,the administration of EGFR tyrosine kinase inhibitor（EGFR-TKIs） shows great benefit in survival.Radiotherapy has specific regional advantage comparing with surgery and chemotherapy.Radiotherapy might activate EGFR signal pathway,induce cell proliferation and enhance DNA repair,so as to leading to the resistance of radiotherapy.So EGFR-TKIs might have the effect of radiotherapy sensibilization.In clinic,the combination of EGFR-TKIs and radiotherapy for regional advanced or metastasis NSCLC shows tolerable side-effect and different survival which might be the effect of different patients chosen.More large samples and multi-centers clinical research of concurrent personal EFGR-TKIs and radiotherapy for unresectable NSCLC with EFGR gene mutation is needed,which may be a kind of first-line treatment in future.