Exploring Thoracic Radiotherapy in Metastatic NSCLC: A Retrospective Review in the Era of Immunotherapy and Targeted...

Lung cancer remains the leading cause of cancer-related deaths worldwide. Advances in immunotherapy and targeted therapies have improved survival in stage IV non-small cell lung cancer (NSCLC), highlighting the importance of local control of the primary tumor. Hypofractionated radiotherapy (hypo-RT), delivering high biologically effective doses (BEDs) over shorter durations, shows potential in locally advanced NSCLC but is underexplored in metastatic settings.

This retrospective study evaluated 104 patients with stage IV NSCLC who received hypo-RT to the primary tumor at LMU Munich between December 2013 and June 2022. The primary endpoints were overall survival (OS) and progression-free survival (PFS), while the secondary endpoints included local failure-free survival, regional failure-free survival, distant failure-free survival, and the identification of prognostic factors.

Median OS and PFS were 15.4 months (95% confidence interval [CI]: 10.5-24.4) and 3.9 months (95% CI, 3.2-6.2), respectively. Significant predictors of OS included Eastern Cooperative Oncology Group performance status >1 (hazard ratio [HR]: 3.260, P = .0003), male sex (HR: 1.869, P = .038), metastases in >2 organ systems (HR: 2.014, P = .022), and BED < 58.5 Gy (HR: 2.117, P = .017). Predictors of PFS included smoking history <30 pack-years (HR: 1.912, P = .003) and BED < 58.5 Gy (HR: 1.816, P = .025).

Hypo-RT is effective and feasible in metastatic NSCLC, with higher BEDs improving survival. Findings highlight the importance of personalized treatment strategies integrating clinical, molecular, and therapeutic factors.