新辅助放疗联合免疫治疗在局部进展期直肠癌中的研究进展  

Progress of immunotherapy combined with neoadjuvant radiotherapy in locally advanced rectal cancer

作　　者：王明非[1,2] 商亮 种微 田锋 李乐平 靖昌庆 WANG Mingfei;SHANG Liang;CHONG Wei;TIAN Feng;LI Leping;JING Changqing(Shandong University,Jinan 250012,China;Department of Gastrointestinal Surgery,Shandong Provincial Hospital,Jinan 250021,China;Department of Gastrointestinal Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东大学,山东济南250012 [2]山东省立医院胃肠外科,山东济南250021 [3]山东第一医科大学附属省立医院胃肠外科,山东济南250021

出　　处：《老年医学研究》2024年第1期62-67,共6页Geriatrics Research

基　　金：山东省重大科技创新工程项目(2021CXGC011104,重大疾病精准预防与诊治综合医疗示范体系的建设与推广)。

摘　　要：随着新辅助治疗发展不断成熟,免疫检查点抑制剂(ICIs)应用于局部进展期直肠癌(LARC)已取得了可喜的突破。相较单纯新辅助放疗及单纯免疫治疗,新辅助放疗联合免疫治疗方案展现出更好的临床及病理完全缓解率。但就具体治疗方案,学界还未达成共识。本文介绍了新辅助放疗联合免疫治疗在LARC中应用的代表性试验结果及最新临床研究,对治疗方案中放疗的具体剂量及分割方式、免疫治疗的周期及联合新辅助放疗的先后顺序、新辅助治疗结束后手术间隔及术后进行辅助治疗与否等关键技术问题进行了归纳总结。从免疫浸润、远隔效应及肠道菌群三个方向对近年来放疗增敏免疫治疗的具体作用机制探索做了系统梳理,同时回顾了可预测新辅助放疗联合免疫治疗在LARC中疗效的标志物研究进展,希望能为LARC临床治疗方案的选择及未来临床研究的设计提供参考与方向。With the rapid development of immunotherapy,immune checkpoint inhibitors(ICIs)have been adminis⁃trated widely in locally advanced rectal cancer(LARC).Compared to single use of neoadjuvant radiotherapy or immuno⁃therapy,the combination of neoadjuvant radiotherapy and immunotherapy shows better clinical and pathological complete response rates.There is still no consensus on key technical issues such as.In this review,we summarized representative results from published trials and the latest clinical trial registered on clinicaltrials.gov.The intervention of neoadjuvant ra⁃diotherapy combined with immunotherapy in LARC is recorded in detail,including the specific dose and fractionation of neoadjuvant radiotherapy,the duration and cycles of immunotherapy,the sequence of combined neoadjuvant radio-immu⁃notherapy,the interval between the end of neoadjuvant therapy and total mesorectal excision(TME)surgery,and the use of postoperative adjuvant therapy.We also concluded the progress of researches on underlying mechanisms of radiotherapyinduced sensitization in tumor immune microenvironment in ways of immunoinfiltration,abscopal effect,and gut microbio⁃ta.At the same time,the research progress of predictive biomarkers for immunotherapy efficacy in LARC is reviewed.It was hoped that this paper will provide reference and guidance for the selection of clinical treatment for LARC and the de⁃sign of future clinical studies.

关 键 词：直肠癌 局部进展期直肠癌 新辅助放疗 免疫治疗 新辅助放疗联合免疫治疗 

分 类 号：R735.37[医药卫生—肿瘤]