| 中国临床肿瘤学会免疫治疗专委会,中华医学会数字医学分会,重庆市中西医结合学会肿瘤免疫治疗专委会,等.胸部放疗联合免疫检查点抑制剂所致间质性肺炎诊疗专家共识(2026年版)[J].中华放射医学与防护杂志,2026,46(3):213-229.Chinese Society of Clinical Oncology (CSCO) Committee on Immunotherapy,Chinese Medical Association Digital Medicine Branch,Chongqing Association for Integrative Medicine Committee on Cancer Immunotherapy,et al.Expert consensus on diagnosis and treatment of interstitial pneumonia induced by thoracic radiotherapy combined with immune checkpoint inhibitors (2026 version)[J].Chin J Radiol Med Prot,2026,46(3):213-229 |
| 胸部放疗联合免疫检查点抑制剂所致间质性肺炎诊疗专家共识(2026年版) |
| Expert consensus on diagnosis and treatment of interstitial pneumonia induced by thoracic radiotherapy combined with immune checkpoint inhibitors (2026 version) |
| 投稿时间：2025-08-13 |
| DOI：10.3760/cma.j.cn112271-20250813-00295 |
| 中文关键词: 胸部放疗 免疫检查点抑制剂 间质性肺炎 多学科诊疗 专家共识 |
| 英文关键词:Thoracic radiotherapy (TRT) Immune checkpoint inhibitor (ICI) Interstitial lung disease (ILD) Multidisciplinary treatment (MDT) Expert consensus |
| 基金项目:国家四大慢病重大专项(2023ZD0502100);重庆市科卫联合医学科研项目(2023DBXM002);重庆市技术创新与应用发展项目(CSTB2022TIAD-KPX0176);重庆市医学领军人才项目(YXLJ202405) |
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| 中文摘要: |
| 胸部放疗(TRT)联合免疫检查点抑制剂(ICIs)可诱发间质性肺炎(ILD),其诊疗缺乏统一标准。多学科专家组基于最新证据制定本共识,旨在规范ILD管理并提升治疗安全性。共识要点包括:TRT诱发的放射性肺炎(RP)与ICIs过度激活免疫系统诱发的免疫性肺炎(CIP),病理机制复杂;二者影像学表现各异但均缺乏特异性;糖皮质激素是分级治疗和动态管理的基础;TRT联合ICIs所致ILD应在多学科诊疗(MDT)指导下精准施治;基础肺疾病是ILD高危因素;对激素抵抗人群需密切监测并个体化调整方案;治疗重启策略应视具体情况而定;不同胸部肿瘤的联合治疗需谨慎评估风险;新型检测技术和人工智能是未来研究方向。本共识为TRT联合ICIs所致ILD提供了全流程管理框架,有助于早期识别,精准干预,降低治疗相关不良反应,提升胸部肿瘤患者生存质量。 |
| 英文摘要: |
| Thoracic radiotherapy (TRT) combined with immune checkpoint inhibitors (ICIs) can induce interstitial lung disease (ILD), for which standardized diagnostic and therapeutic protocols are currently lacking. A multidisciplinary expert panel has developed this consensus based on the latest evidence to standardize ILD management and enhance treatment safety. The consensus outlines the following key points: Radiation pneumonitis (RP), resulting from radiotherapy injury, and checkpoint inhibitor pneumonitis (CIP), driven by immune hyperactivation, exhibit complex pathogenesis with distinct imaging features, yet share non-specific manifestations. Corticosteroids are foundational for graded treatment and dynamic management. Management of TRT-ICIs-associated ILD requires precise guidance under multidisciplinary treatment (MDT). Pre-existing lung diseases are significant risk factors for ILD. Close monitoring and individualized adjustments are crucial for steroid-resistant populations. Treatment rechallenge strategies should be tailored to individual patient conditions. Combined therapy for various thoracic tumors necessitates careful risk assessment. Novel detection technologies and artificial intelligence (AI) represent future research directions. This consensus provides a comprehensive framework for the whole-process management of ILD induced by TRT combined with ICIs. It will help conduct early detection and precise intervention, reduce treatment-related adverse reactions, and improve the quality of life of patients with thoracic tumors. |
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