Chemoimmunotherapy With or Without Thoracic Radiotherapy for Elderly Patients in Advanced Non-Small Cell Lung Cancer

The optimal integration of thoracic radiotherapy (TRT) with first-line chemoimmunotherapy for elderly patients with driver-negative advanced non-small cell lung cancer (NSCLC) remains undefined. We conducted a real-world study to assess the efficacy and safety of this triple-modality therapy specifically in patients aged ≥ 65 years. We designed a retrospective analysis of elderly patients with stage IV, mutation-negative NSCLC who underwent first-line platinum-based chemotherapy combined with immunotherapy at our institution between November 2019 and September 2024. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, and differences between groups were compared with the log-rank test. After a median follow-up of 22.34 months, the addition of TRT yielded numerically longer but statistically non-significant median PFS (12.20 vs. 10.17 months; p = 0.24) and OS (29.67 vs. 18.65 months; p = 0.09). Subgroup analysis suggested a potential survival trend with triple therapy in patients aged 65-70 years, whereas no benefit was observed in those aged ≥ 70 years. Notably, treatment discontinuation due to adverse events was significantly more frequent in the Chemo+ICI+TRT group, with pneumonia being the predominant cause. For elderly patients with advanced NSCLC, particularly those aged ≥ 70 years, incorporating TRT into first-line chemoimmunotherapy did not significantly improve survival but substantially increased toxicity, often leading to treatment interruption. A potential benefit observed in patients aged 65-70 years requires prospective validation. These results highlight the critical need for personalized treatment intensity in geriatric oncology.