引用文本：杨潇, 孙婉君, 张恒, 等. 放射治疗联合免疫检查点抑制剂治疗结直肠癌的研究进展[J/CD]. 消化肿瘤杂志（电子版）, 2025, 17(4): 538-546.

作者：杨潇1,2，孙婉君3，张恒3，王辉3

单位：1. 天津市人民医院（南开大学第一附属医院）消化内科2（内镜诊疗中心），天津 300121；2. 南开大学医学院，天津 300071；3. 天津市人民医院（南开大学第一附属医院）肿瘤诊疗中心，天津 300121

Authors：Yang Xiao1,2, Sun Wanjun3, Zhang Heng3, Wang Hui3

Unit：1. Department of Gastroenterology Ⅱ (Endoscopy Center), Tianjin Union Medical Center, the First Affiliated Hospital of Nankai University, Tianjin 300121, China；2. Medicine School, Nankai University, Tianjin 300071, China；3. Department of Oncology, Tianjin Union Medical Center, the First Affiliated Hospital of Nankai University, Tianjin 300121, China

摘要：

放射治疗不仅可以直接杀伤肿瘤细胞，还可诱导免疫原性细胞死亡、激活环鸟苷酸-腺苷酸合成酶‑干扰素基因刺激因子通路并重塑肿瘤微环境，从而启动和放大抗肿瘤免疫效应。免疫检查点抑制剂则可解除T细胞功能抑制。二者联合治疗结直肠癌显示出“1+1>2”的协同效应。本文梳理了联合治疗的作用机制、转化研究进展和临床证据，重点讨论高微卫星不稳定（microsatellite instability-high, MSI-H）/错配修复缺陷（deficient mismatch repair, dMMR）与微卫星稳定（microsatellite stability, MSS）/错配修复完整（proficient mismatch repair，pMMR）亚型差异、剂量分割模式以及生物标志物预测价值，并总结远隔效应和毒性管理策略，为优化结直肠癌综合治疗提供参考。

关键词：结直肠癌；放射治疗；免疫检查点抑制剂；肿瘤微环境

Abstract：

Radiotherapy causes direct DNA damage and elicits immunogenic cell death, activates the cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway, and remodels the tumor microenvironment, thereby priming systemic anti‑tumor immunity. Immune checkpoint inhibitors (ICIs) release inhibitory signals on cytotoxic T cells. Mounting evidence demonstrates a synergistic "1+1 >2" interaction between these modalities in colorectal cancer. This review summarizes the mechanistic rationale, translational innovations, and clinical progress of combining radiotherapy with ICIs for colorectal cancer. The article also highlights the divergent responses of microsatellite instability-high (MSI‑H)/ deficient mismatch repair (dMMR) versus microsatellite stability (MSS)/ proficient mismatch repair (pMMR) tumours, discusses the impact of dose fractionation, identifies emerging predictive biomarkers, and outlines approaches to harness abscopal effects while mitigating toxicity. Practical recommendations for patient selection, radiotherapy planning, and combination sequencing are proposed to maximise therapeutic gain in colorectal cancer.

Key words：Colorectal cancer; Radiotherapy; Immune checkpoint inhibitors; Tumor microenvironment

注：网络优先发布