Monaca Federico, Gomez-Randulfe Igor, Walls Gerard, Cantale Ornella, Parreira Ana, Polidori Sara, Di Salvatore Mariantonietta, Longo Vito, Galetta Domenico, Vita Emanuele, Martino Antonella, Gambacorta Maria Antonietta, Boldrini Luca, Summers Yvonne, Tortora Giampaolo, Blackhall Fiona, Novello Silvia, Chan Clara, Bria Emilio, Faivre-Finn Corinne, Califano Raffaele
Università Cattolica del Sacro Cuore, Rome, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
Eur J Cancer. 2025 Jul 25;225:115592. doi: 10.1016/j.ejca.2025.115592. Epub 2025 Jun 25.
The CREST trial established the benefit of consolidative thoracic radiotherapy (TRT) following first line (1L) chemotherapy in extensive-stage small cell lung cancer (ES-SCLC), demonstrating improved 2-year overall survival (OS). However, the role of TRT in the chemoimmunotherapy (CT-IO) era remains unclear, as TRT was excluded from registrational trials.
This retrospective study analysed consecutive patients (pts) with ES-SCLC treated with 1L CT-IO between January 2020 and January 2024 across 4 centres. Pts without radiological progression (PD) at their first post-treatment assessment were included. Intrathoracic recurrence rates, progression-free survival (PFS), and OS were compared between pts who received TRT and those who did not.
336 pts were identified, with 111 (33.0 %) receiving TRT. Pts who received TRT had a lower rate of intrathoracic PD compared to those who did not (40.5 % vs 57.8 %, p = 0.003). Among those with intrathoracic PD despite TRT, only 21 (24.1 %) experienced PD within the radiation field. With a median follow-up of 31.3 months, pts who received TRT showed improved PFS (HR 0.89, p = 0.363) and OS (HR 0.82, p = 0.142), although not statistically significant. Multivariate analysis identified baseline liver metastases (LM) and stable disease after CT-IO as independent predictors of shorter PFS. Subgroup analysis revealed a longer PFS for pts receiving higher TRT doses (≥45 Gy vs <45 Gy) and those without LM.
In this series, TRT following 1 L CT-IO significantly improved intrathoracic control, although it did not translate into significantly better survival outcomes. Prospective trials are warranted to evaluate the impact of TRT on quality of life and survival.
CREST试验证实了广泛期小细胞肺癌（ES-SCLC）一线（1L）化疗后巩固性胸部放疗（TRT）的益处，显示2年总生存期（OS）有所改善。然而，由于TRT被排除在注册试验之外，其在化疗免疫治疗（CT-IO）时代的作用仍不明确。
这项回顾性研究分析了2020年1月至2024年1月期间4个中心接受1L CT-IO治疗的连续性ES-SCLC患者（pts）。纳入首次治疗后评估时无影像学进展（PD）的患者。比较接受TRT和未接受TRT的患者的胸内复发率、无进展生存期（PFS）和OS。
共纳入336例患者，其中111例（33.0%）接受了TRT。接受TRT的患者胸内PD发生率低于未接受TRT的患者（40.5%对57.8%，p = 0.003）。在接受TRT后仍发生胸内PD的患者中，只有21例（24.1%）在放射野内发生PD。中位随访31.3个月，接受TRT的患者PFS（HR 0.89，p = 0.363）和OS（HR 0.82，p = 0.142）有所改善，尽管无统计学意义。多因素分析确定基线肝转移（LM）和CT-IO后疾病稳定是PFS较短的独立预测因素。亚组分析显示，接受较高TRT剂量（≥45 Gy对<45 Gy）的患者和无LM的患者PFS更长。
在本系列研究中，1L CT-IO后进行TRT可显著改善胸内控制，尽管未转化为显著更好的生存结果。有必要进行前瞻性试验以评估TRT对生活质量和生存的影响。
