Wang Yunfeng, Su Xi, Jia Jingyi, Zhou Tongfang, Lu Yifei, Zhao Lei, Yang Zhangru, Fu Xiaolong, Zeng Ya, Cai Xuwei
Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
BMC Cancer. 2025 Jun 6;25(1):1012. doi: 10.1186/s12885-025-14417-0.
This real-world study aimed to investigate the efficacy of early radiotherapy (RT) in ES-SCLC patients treated with first-line chemo-immunotherapy.
ES-SCLC patients were enrolled from August 2018 to October 2023. Patients who received early radiotherapy before disease progression were defined as Early RT group, while the others, named Salvage and Non-RT (S&N RT) group. Propensity score matching (PSM) with a 1:1 ratio was performed to balance the baseline characteristics.
In this study, 375 patients with ES-SCLC treated with first-line chemo-immunotherapy were enrolled. The median PFS was 11.4 months of the Early RT group compared to 6.1 months of the S&N RT group (HR = 0.59, 95%CI 0.45-0.77; p < 0.001). The median OS was 23.8 months of the Early RT group versus 18.0 months of the S&N RT group (HR = 0.50, 95%CI 0.34-0.73; p = 0.004). The survival benefit persisted in the PSM cohort. Furthermore, survival was significantly improved in Early RT group compared to Salvage RT group (p = 0.028), while Salvage RT group had a similar survival with Non-RT group (p = 0.868). The risk of adverse events was tolerable. The multivariate analysis also demonstrated that early radiotherapy was an independently positive predictor for PFS and OS.
Administering early radiotherapy significantly improved both PFS and OS in patients with ES-SCLC treated with first-line chemo-immunotherapy with tolerable adverse events, while salvage radiotherapy did not improve survival. This finding warrants further validation through prospective randomized studies.
本真实世界研究旨在探讨早期放疗（RT）在接受一线化疗免疫治疗的广泛期小细胞肺癌（ES-SCLC）患者中的疗效。
2018年8月至2023年10月纳入ES-SCLC患者。在疾病进展前接受早期放疗的患者被定义为早期放疗组，其他患者则被命名为挽救性放疗和非放疗（S&N RT）组。采用1:1比例的倾向评分匹配（PSM）来平衡基线特征。
本研究共纳入375例接受一线化疗免疫治疗的ES-SCLC患者。早期放疗组的中位无进展生存期（PFS）为11.4个月，而S&N RT组为6.1个月（风险比[HR]=0.59，95%置信区间[CI]0.45-0.77；p<0.001）。早期放疗组的中位总生存期（OS）为23.8个月，而S&N RT组为18.0个月（HR=0.50，95%CI 0.34-0.73；p=0.004）。生存获益在PSM队列中持续存在。此外，与挽救性放疗组相比，早期放疗组的生存率显著提高（p=0.028），而挽救性放疗组与非放疗组的生存率相似（p=0.868）。不良事件风险可耐受。多因素分析还表明，早期放疗是PFS和OS的独立阳性预测因素。
在接受一线化疗免疫治疗的ES-SCLC患者中，早期放疗显著改善了PFS和OS，不良事件可耐受，而挽救性放疗并未改善生存率。这一发现值得通过前瞻性随机研究进一步验证。
