Advances in Radiotherapy for Neoadjuvant Therapy of Stage III Non-Small Cell Lung Cancer

This review aims to systematically summarize the mechanisms of action, clinical evolution, and application prospects of radiotherapy in neoadjuvant therapy for stage III non-small cell lung cancer. Focusing on three core techniques: spatially fractionated radiotherapy, stereotactic body radiotherapy, and low-dose radiotherapy, key study data were screened across different treatment eras. Data extraction covers the unique mechanisms of the three radiotherapy modalities, as well as the efficacy and safety of treatment regimens before and after the immunotherapy era, including pathological response rate, survival benefit, adverse reactions, and other core endpoints. Comprehensive data analysis indicates that the three radiotherapy techniques have distinct characteristics; radioimmunotherapy synergy and triple regimens in the immunotherapy era significantly improve pathological response rates and long-term disease control. Spatially fractionated radiotherapy demonstrates unique advantages due to its low toxicity and dual mechanisms of action. In conclusion, radiotherapy shows prominent value in neoadjuvant therapy for stage III non-small cell lung cancer, and spatially fractionated radiotherapy is expected to become an important therapeutic option. However, its optimal dose-fractionation regimen, standardized procedures, and other issues still require further validation by multicenter randomized controlled trials to promote the development of more precise, safe, and effective treatments.