Definitive radiotherapy provides comparable survival with lower toxicity compared with concurrent chemoradiotherapy after long-course induction chemoimmunotherapy in unresectable non-small-cell lung cancer.
长疗程诱导化疗免疫治疗（⩾3个周期）越来越多地用于不可切除非小细胞肺癌（NSCLC）的降期。然而，对于诱导治疗后仍无法手术的患者，单纯根治性放疗（RT）与同步放化疗（CRT）之间的最佳根治性局部治疗方式仍不明确。旨在比较不可切除NSCLC患者在接受诱导化疗免疫治疗后，根治性放疗与同步放化疗的生存和毒性结局。这是一项单中心回顾性队列研究，采用稳定逆概率治疗加权（sIPTW）来平衡治疗组间的基线特征。纳入连续收治的、无可靶向驱动基因突变、经长疗程诱导化疗免疫治疗后仍无法手术、随后接受根治性放疗或同步放化疗的不可切除NSCLC患者。采用Kaplan-Meier法估计无进展生存期（PFS）和总生存期（OS），并使用加权Cox比例风险模型进行比较。治疗相关不良事件根据常见不良事件评价标准进行分级。一项探索性分析评估了巩固免疫治疗与PFS之间的关联。共纳入153例患者（放疗组63例；同步放化疗组90例）。中位随访25.8个月时，放疗组1年和2年PFS率分别为83.5%和54.3%，同步放化疗组分别为82.1%和61.1%（风险比（HR）=0.83；95%置信区间（CI），0.51-1.37；=0.46）。经sIPTW校正后，PFS仍相当（HR=0.80；95%CI，0.47-1.35；=0.46）。两组OS也相似。同步放化疗组3-4级血液学毒性更常见（24.4%对9.5%；<0.001）。巩固免疫治疗与PFS数值上的改善相关，但无统计学意义（HR=0.78；95%CI，0.48-1.27；=0.32）。在长疗程诱导化疗免疫治疗后仍无法手术的不可切除NSCLC患者中，单纯根治性放疗提供的生存结局与同步放化疗相当，同时减少了严重血液学毒性。在这种情况下，对于经过仔细筛选的患者，单纯放疗可能是一个合理的根治性选择。
Long-course induction chemoimmunotherapy (⩾3 cycles) is increasingly used to downstage unresectable non-small-cell lung cancer (NSCLC). However, the optimal definitive local treatment for patients who remain inoperable after induction-definitive radiotherapy (RT) alone versus concurrent chemoradiotherapy (CRT)-remains unclear. To compare survival and toxicity outcomes between definitive RT and CRT following induction chemoimmunotherapy in unresectable NSCLC. This was a single-center retrospective cohort study using stable inverse probability of treatment weighting (sIPTW) to balance baseline characteristics between treatment groups. Consecutive patients with unresectable NSCLC without known actionable driver mutations who remained inoperable after long-course induction chemoimmunotherapy and subsequently received definitive RT or CRT were included. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier methods and compared with weighted Cox proportional hazards models. Treatment-related adverse events were graded according to the Common Terminology Criteria for Adverse Events. An exploratory analysis evaluated the association between consolidation immunotherapy and PFS. A total of 153 patients were included (RT, = 63; CRT, = 90). At a median follow-up of 25.8 months, the 1- and 2-year PFS rates were 83.5% and 54.3% in the RT group, compared with 82.1% and 61.1% in the CRT group (hazard ratio (HR) = 0.83; 95% confidence interval (CI), 0.51-1.37; = 0.46). After sIPTW adjustment, PFS remained comparable (HR = 0.80; 95% CI, 0.47-1.35; = 0.46). OS was also similar between groups. Grade 3-4 hematologic toxicity was more frequent with CRT (24.4% vs 9.5%; < 0.001). Consolidation immunotherapy was associated with a numerical but non-significant PFS improvement (HR = 0.78; 95% CI, 0.48-1.27; = 0.32). In patients with unresectable NSCLC who remain inoperable after long-course induction chemoimmunotherapy, definitive RT alone provides survival outcomes comparable to CRT while reducing severe hematologic toxicity. RT alone may represent a reasonable definitive option for carefully selected patients in this setting.
Xiao Chang, Huifang Liang, Jiayi Xiao, Dan Yang, Jiayi Yu, Jiahui Shan, et al. Definitive radiotherapy provides comparable survival with lower toxicity compared with concurrent chemoradiotherapy after long-course induction chemoimmunotherapy in unresectable non-small-cell lung cancer.. Therapeutic advances in medical oncology. 2026; doi:10.1177/17588359261447969.
Xiao Chang, Huifang Liang, Jiayi Xiao, Dan Yang, Jiayi Yu, Jiahui Shan, et al (2026). Definitive radiotherapy provides comparable survival with lower toxicity compared with concurrent chemoradiotherapy after long-course induction chemoimmunotherapy in unresectable non-small-cell lung cancer.. Therapeutic advances in medical oncology. https://doi.org/10.1177/17588359261447969
Xiao Chang, Huifang Liang, Jiayi Xiao, Dan Yang, Jiayi Yu, Jiahui Shan, et al. Definitive radiotherapy provides comparable survival with lower toxicity compared with concurrent chemoradiotherapy after long-course induction chemoimmunotherapy in unresectable non-small-cell lung cancer.[J]. Therapeutic advances in medical oncology, 2026 doi:10.1177/17588359261447969.
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