Du Zhe, Zhao Yuting, Du Lehui, Shi Anhui, Yu Huiming, Guo Xingdong, Yu Rong, Qu Baolin, Wang Weihu
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
Department of Radiation Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
J Thorac Dis. 2025 Aug 31;17(8):5904-5920. doi: 10.21037/jtd-2024-2255. Epub 2025 Aug 28.
Immune checkpoint inhibitors (ICIs) as part of first-line treatment are becoming increasingly significant in metastatic non-small cell lung cancer (NSCLC). We aimed to investigate the efficacy and safety of thoracic radiotherapy (TRT) in addition to first-line ICIs in metastatic NSCLC.
From January 2017 to August 2023, we retrospectively collected the information of 82 patients with metastatic NSCLC who were treated with first-line ICIs and radiotherapy (RT). Patients were divided into the TRT group (n=35) and the non-TRT group (n=47). The efficacy and safety were analyzed. Propensity score matching (PSM) was applied. Inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis.
The median follow-up was 31.4 months (range, 4.0-81.4 months). Before PSM, the median overall survival (OS; 38.1 . 17.9 months, P=0.01) and median progression-free survival (PFS; 14.9 . 8.3 months, P=0.001) were significantly improved in the TRT group. After PSM, there were 18 patients in each group. Both the median OS [not reached (NR) . 26.8 months, P=0.02] and median PFS (16.3 . 7.5 months, P<0.001) still favored in the TRT group. The IPTW method yielded similar results [OS: hazard ratio (HR) =0.335, P=0.01; PFS: HR =0.442, P=0.02]. The most common grade 3 or worse toxicity was bone marrow suppression (18/82, 22.0%). No significant difference was found in grade 3 or worse treatment-related pneumonia between the two groups either before (5.7% . 6.4%, P>0.99) or after matching (0 . 5.6%, P>0.99).
The addition of TRT to first-line immunotherapy (IO) may be associated with improved survival in metastatic NSCLC. However, given the retrospective nature and limited sample size, these findings are exploratory and warrant validation in larger randomized trials.
免疫检查点抑制剂（ICI）作为一线治疗的一部分，在转移性非小细胞肺癌（NSCLC）中的作用日益显著。我们旨在研究在转移性NSCLC中，除一线ICI治疗外，胸部放疗（TRT）的疗效和安全性。
2017年1月至2023年8月，我们回顾性收集了82例接受一线ICI和放疗（RT）治疗的转移性NSCLC患者的信息。患者分为TRT组（n = 35）和非TRT组（n = 47）。分析疗效和安全性。应用倾向评分匹配（PSM）。采用治疗权重逆概率（IPTW）进行敏感性分析。
中位随访时间为31.4个月（范围4.0 - 81.4个月）。在PSM之前，TRT组的中位总生存期（OS；38.1对17.9个月，P = 0.01）和中位无进展生存期（PFS；14.9对8.3个月，P = 0.001）显著改善。PSM后，每组有18例患者。TRT组的中位OS[未达到（NR）对26.8个月，P = 0.02]和中位PFS（16.3对7.5个月，P < 0.001）仍占优势。IPTW方法得出类似结果[OS：风险比（HR）= 0.335，P = 0.01；PFS：HR = 0.442，P = 0.02]。最常见的3级或更严重毒性是骨髓抑制（18/82，22.0%）。两组在匹配前（5.7%对6.4%，P > 0.99）或匹配后（0对5.6%，P > 0.99）3级或更严重的治疗相关肺炎方面均未发现显著差异。
在一线免疫治疗（IO）中加入TRT可能与转移性NSCLC患者生存率提高有关。然而，鉴于研究的回顾性性质和样本量有限，这些发现具有探索性，需要在更大规模的随机试验中进行验证。
