Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, 250117, Shandong, China.
Department of Thoracic Department, Hunan Cancer Hospital, Changsha, China.
Radiat Oncol. 2023 Jul 4;18(1):111. doi: 10.1186/s13014-023-02308-2.
The CREST study showed that the addition of thoracic radiotherapy (TRT) could improve the survival rate in patients with extensive stage small cell lung cancer (ES-SCLC), but whether TRT can bring survival benefit in the era of immunotherapy remains controversial. This study aimed to explore the efficacy and safety of adding TRT to the combination of PD-L1 inhibitors and chemotherapy.
The patients who received durvalumab or atezolizumab combined with chemotherapy as the first-line treatment of ES-SCLC from January 2019 to December 2021 were enrolled. They were divided into two groups, based on whether they received TRT or not. Propensity score matching (PSM) with a 1:1 ratio was performed. The primary endpoints were progression-free survival (PFS), overall survival (OS) and safety.
A total of 211 patients with ES-SCLC were enrolled, of whom 70 (33.2%) patients received standard therapy plus TRT as first-line treatment, and 141 (66.8%) patients in the control group received PD-L1 inhibitors plus chemotherapy. After PSM, a total of 57 pairs of patients were enrolled in the analysis. In all patients, the median PFS (mPFS) in the TRT and non-TRT group was 9.5 and 7.2 months, respectively, with HR = 0.59 (95%CI 0.39-0.88, p = 0.009). The median OS (mOS) in the TRT group was also significantly longer than that in the non-TRT group (24.1 months vs. 18.5 months, HR = 0.53, 95%CI 0.31-0.89, p = 0.016). Multivariable analysis showed that baseline liver metastasis and the number of metastases ≥ 3 were independent prognostic factors for OS. Addition of TRT increased the incidence of treatment-related pneumonia (p = 0.018), most of which were grade 1-2.
Addition of TRT to durvalumab or atezolizumab plus chemotherapy significantly improves survival in ES-SCLC. Although it may leads to increased incidence of treatment-related pneumonia, a majority of the cases can be relieved after symptomatic treatment.
CREST 研究表明，胸部放疗（TRT）的加入可以提高广泛期小细胞肺癌（ES-SCLC）患者的生存率，但 TRT 是否能在免疫治疗时代带来生存获益仍存在争议。本研究旨在探讨 PD-L1 抑制剂联合化疗加用 TRT 的疗效和安全性。
本研究纳入了 2019 年 1 月至 2021 年 12 月接受度伐利尤单抗或阿替利珠单抗联合化疗作为 ES-SCLC 一线治疗的患者。根据是否接受 TRT 将患者分为两组，并进行 1:1 倾向评分匹配（PSM）。主要终点为无进展生存期（PFS）、总生存期（OS）和安全性。
共纳入 211 例 ES-SCLC 患者，其中 70 例（33.2%）患者接受标准治疗加 TRT 作为一线治疗，141 例（66.8%）患者在对照组接受 PD-L1 抑制剂联合化疗。PSM 后，共纳入 57 对患者进行分析。在所有患者中，TRT 组和非 TRT 组的中位 PFS（mPFS）分别为 9.5 和 7.2 个月，HR=0.59（95%CI 0.39-0.88，p=0.009）。TRT 组的中位 OS（mOS）也明显长于非 TRT 组（24.1 个月 vs. 18.5 个月，HR=0.53，95%CI 0.31-0.89，p=0.016）。多变量分析显示，基线肝转移和转移灶≥3 个是 OS 的独立预后因素。加用 TRT 增加了治疗相关肺炎的发生率（p=0.018），大多数为 1-2 级。
在度伐利尤单抗或阿替利珠单抗联合化疗的基础上加用 TRT 可显著提高 ES-SCLC 的生存率。虽然可能会导致治疗相关肺炎的发生率增加，但大多数病例在对症治疗后可缓解。
