Liu Lipin, Gao Cui, Yang Yufan, Tang Min, Zhao Ting, Chen Dazhi, Jin Jingyi, Xu Yonggang, Li Gaofeng, Zhong Qiuzi
Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China.
Department of Medical Oncology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China.
Radiat Oncol. 2025 Mar 13;20(1):37. doi: 10.1186/s13014-025-02616-9.
Immune checkpoint inhibitor (ICI) has displayed considerable advantages in consolidation therapy of locally advanced non-small cell lung cancer (LA-NSCLC) after concurrent chemoradiotherapy (cCRT). However, many patients are considered unsuitable for cCRT owing to concerns with tolerability. In this study, we aimed to assess the efficacy and toxicity of induction immunochemotherapy followed by radiotherapy for unresectable LA-NSCLC who are not capable of receiving cCRT.
From January 2019 and December 2022, LA-NSCLC patients treated with induction immunochemotherapy followed by radiotherapy as initial treatment at our institution were retrospectively reviewed. The short-term efficacy, overall survival (OS), progression free survival (PFS) and tolerability of induction immunochemotherapy followed by radiotherapy were evaluated in these patients.
Overall, 24 patients were enrolled (median age 64 years, 33.3% with ECOG performance status score 2, and 62.5% with stage IIIB-IIIC). Median follow-up from the start of induction immunochemotherapy was 30.5 months. Median number of induction immunochemotherapy was 4 cycles. A median radiotherapy dose of 60 Gy was delivered. After radiotherapy, 16 patients (66.6%) received consolidation immunotherapy. The overall response rate in these patients was 87.5%. The 1-year, 2-year and 3-year OS were 91.7%, 74.8% and 57.0%, respectively. The 1-year, 2-year and 3-year PFS were 87.0%, 54.1% and 37.1%, respectively. The incidence of grade ≥ 2 and grade ≥ 3 pneumonitis were 37.5% and 16.7%, respectively. Radiation pneumonitis of any grade occurred in 8 patients (33.3%), and the incidence of grade ≥ 2 and grade ≥ 3 radiation pneumonitis were 16.7% and 12.5%, respectively.
Induction immunochemotherapy followed by radiotherapy and consolidated immunotherapy had encouraging efficacy with acceptable toxicity for LA-NSCLC not capable of receiving cCRT.
免疫检查点抑制剂（ICI）在同步放化疗（cCRT）后的局部晚期非小细胞肺癌（LA-NSCLC）巩固治疗中显示出显著优势。然而，由于对耐受性的担忧，许多患者被认为不适合cCRT。在本研究中，我们旨在评估诱导免疫化疗后放疗对无法接受cCRT的不可切除LA-NSCLC的疗效和毒性。
回顾性分析2019年1月至2022年12月在我院接受诱导免疫化疗后放疗作为初始治疗的LA-NSCLC患者。评估这些患者诱导免疫化疗后放疗的短期疗效、总生存期（OS）、无进展生存期（PFS）和耐受性。
共纳入24例患者（中位年龄64岁，33.3%的东部肿瘤协作组体能状态评分为2分，62.5%为ⅢB-IIIC期）。从诱导免疫化疗开始的中位随访时间为30.5个月。诱导免疫化疗的中位周期数为4个周期。中位放疗剂量为60 Gy。放疗后，16例患者（66.6%）接受巩固免疫治疗。这些患者的总缓解率为87.5%。1年、2年和3年总生存率分别为91.7%、74.8%和57.0%。1年、2年和3年无进展生存率分别为87.0%、54.1%和37.1%。≥2级和≥3级肺炎的发生率分别为37.5%和16.7%。8例患者（33.3%）发生任何级别的放射性肺炎，≥2级和≥3级放射性肺炎的发生率分别为16.7%和12.5%。
对于无法接受cCRT的LA-NSCLC，诱导免疫化疗后放疗及巩固免疫治疗具有令人鼓舞的疗效且毒性可接受。
