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中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (05) : 905 -909. doi: 10.3877/cma.j.issn.1674-6902.2026.05.029

综述

Ⅲ期不可切除非小细胞肺癌治疗新进展
周叶娟1, 王永兵1,†(), 李艳2   
  1. 1405200 重庆,重庆市梁平区人民医院肿瘤科
    2400030 重庆,重庆大学附属肿瘤医院肿瘤内科
  • 收稿日期:2026-03-16 出版日期:2026-10-25
  • 通信作者: 王永兵

New advances in the treatment of stage Ⅲ unresectable non-small cell lung cancer

Yejuan Zhou, Yongbing Wang†(), Yan Li   

  • Received:2026-03-16 Published:2026-10-25
  • Corresponding author: Yongbing Wang
引用本文:

周叶娟, 王永兵, 李艳. Ⅲ期不可切除非小细胞肺癌治疗新进展[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(05): 905-909.

Yejuan Zhou, Yongbing Wang, Yan Li. New advances in the treatment of stage Ⅲ unresectable non-small cell lung cancer[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(05): 905-909.

Ⅲ期不可切除非小细胞肺癌(nonsmall cell lung cancer, NSCLC)属于局部晚期肿瘤,异质性显著,临床治疗难度较高。既往根治性同步放化疗为标准方案,但患者局部复发、远处转移风险高,远期生存及整体预后不佳。近年来,伴随精准放疗、免疫、靶向药物的发展以及生物标志物检测体系的完善,Ⅲ期不可切除NSCLC的治疗理念发生根本转变,由单一放化疗模式进入放化疗、免疫与靶向相结合的个体化分层综合治疗时代。以PACIFIC系列研究为代表的临床试验确立了同步放化疗后免疫巩固治疗的标准地位,度伐利尤单抗、舒格利单抗等程序性死亡配体1(programmed deathligand 1, PDL1)抑制剂,能够延长患者无进展生存期(progressionfree survival, PFS)与总生存期(overall survival, OS),降低肿瘤复发转移风险,安全性良好,有效提升长期生存获益。调强放疗(intensitymodulated radiation therapy, IMRT)、自适应放疗(adaptive radiation therapy, ART)、图像引导放疗(imageguided radiation therapy, IGRT)等精准放疗技术,可精准覆盖肿瘤靶区,减少心肺正常组织受照损伤,降低放射性肺炎、食管炎等不良反应,提升治疗耐受性,使高龄、合并基础疾病患者获得治疗机会。序贯放化疗(sequential chemoradiotherapy, sCRT)联合免疫巩固,为无法耐受同步放化疗的患者提供重要替代选择。针对表皮生长因子受体(epidermal growth factor receptor, EGFR)、间变性淋巴瘤激酶(anaplastic lymphoma kinase, ALK)驱动基因突变人群,常规免疫治疗获益有限,放化疗联合靶向维持、靶向诱导降期转化成为重要探索方向。PDL1表达、循环肿瘤DNA(circulating tumor DNA, ctDNA)、微小残留病灶(minimal residual disease, MRD)及影像组学等生物标志物,有助于筛选免疫获益人群、评估疗效、预判复发风险,指导方案与巩固疗程制定。当前临床仍面临免疫相关不良反应管理、驱动基因阳性患者治疗手段有限、老年体弱人群耐受性不足、复发转移机制复杂等难题,双免疫联合、新型靶点抑制剂尚处在临床探索阶段。本文梳理近年Ⅲ期不可切除NSCLC放疗、免疫、靶向领域研究进展,归纳不同人群个体化策略与临床争议,剖析现存瓶颈与发展方向,为优化局部晚期NSCLC综合治疗、改善患者远期预后提供循证参考。

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