Comment irradier un patient sous traitement systémique (thérapie ciblée, immunothérapie, ADC) ?

In patients with oligometastatic NSCLC (less than 5 metastatic sites in 3 or fewer organs), treatment is based on systemic therapy chosen according to the anatomopathological result and the molecular profile. Randomized studies have shown that adding local ablative treatment to systemic treatment can improve the outcome of these patients. Radiotherapy, and more specifically stereotactic radiotherapy (SRT), has been the most studied LAT. The systemic treatments most frequently associated with SRT are targeted therapies in patients with NSCLC with driver mutation and immunotherapy in the majority of patients with NSCLC without any driver mutation. Systemic treatment is most often continued, sometimes interrupted briefly depending on the molecule. Thus, SRT is often administered in less than 5 sessions, at a variable total dose. The decision should be individualized and validated in a multidisciplinary meeting. Ideally such patients should be included in trials.