Stereotactic Versus Standard Tumor Irradiation in Unresectable Locally Advanced Non-small Cell Lung Cancer With...

Area of Science:

• Oncology
• Radiation Oncology
• Thoracic Oncology

Background:

• Tumor control is crucial for locally advanced non-small cell lung cancer (LA-NSCLC) prognosis.
• Ongoing research focuses on dose-escalation strategies to improve outcomes in LA-NSCLC.
• Standard treatment involves normofractionated chemoradiation followed by immunotherapy.

Purpose of the Study:

• To evaluate the efficacy and safety of tumor stereotactic body radiation therapy (T-SBRT).
• To compare T-SBRT with standard normofractionated chemoradiation followed by immunotherapy in LA-NSCLC.
• To assess progression-free survival (PFS) and overall survival (OS) outcomes.

Main Methods:

• Retrospective multicenter study of unresectable LA-NSCLC patients (July 2017-January 2023).
• Patients received normofractionated radiation therapy (≥60 Gy), chemotherapy (≥1 cycle), and durvalumab (≥1 cycle).
• T-SBRT group received mediastinal normofractionated RT and ultrahypofractionated primary tumor irradiation; propensity score matching (PSM) was used.

Main Results:

• 208 patients included; 21 (10%) received T-SBRT. Median follow-up: 38 months.
• T-SBRT significantly improved PFS in the overall cohort (HR=0.46, P=0.046) and after PSM (HR=0.41, P=0.031).
• T-SBRT showed a trend toward improved OS (overall cohort HR=0.54, P=0.18; PSM cohort HR=0.46, P=0.11) with comparable acute grade 3 toxicities.

Conclusions:

• T-SBRT in LA-NSCLC is associated with significantly longer PFS and a trend toward improved OS.
• T-SBRT did not increase toxicity compared to standard treatment.
• Further research is needed to optimize T-SBRT timing and explore immunologic synergy.