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Published on: February 12, 2017
Consolidative thoracic radiotherapy after first-line chemoimmunotherapy in extensive-stage small-cell lung cancer: a
Shengxin Zhang1, Nan Lin1, Xiaojuan Gu2
1Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China.
Background:
While consolidative thoracic radiotherapy (cTRT) is standard after chemotherapy for extensive-stage small-cell lung cancer (ES-SCLC), its role in the immunotherapy era remains unclear, and this study provides real-world evidence on its survival benefit and safety.
Methods:
This multicenter, retrospective cohort study included patients diagnosed with ES-SCLC who underwent first-line chemoimmunotherapy from January 2019 to October 2024. Participants were stratified by receipt of cTRT. Overall survival (OS) was the primary endpoint; secondary endpoints included progression-free survival (PFS), thoracic relapse, extrathoracic relapse lesions, and treatment-related adverse events. Survival analyses were performed using a 3-month landmark cohort as the primary analytical approach, with propensity score matching and time-dependent Cox regression as sensitivity analyses, and robustness assessed by E-value.
Results:
Among 171 patients (cTRT, n=91; non-cTRT, n=80; median follow-up 41.3 months), cTRT significantly improved median OS [13.4 vs. 9.9 months, adjusted hazard ratio (HR) 0.37, 95% confidence interval (CI): 0.15-0.91, P=0.03] and PFS (9.2 vs. 7.2 months, adjusted HR 0.22, 95% CI: 0.11-0.43, P<0.001). Intrathoracic recurrence was numerically lower with cTRT, and safety was manageable. Multivariable analysis identified cTRT, immunotherapy cycles, and the granulocyte-to-lymphocyte ratio (GLR) (nonlinear, inflection point 2.95) as independent prognostic factors. Exploratory cTRT subgroup analysis showed that a higher radiation dose improved PFS (HR 0.45, P=0.02) vs. the low-dose group, with sensitivity analyses [propensity score matching (PSM), time-dependent Cox, E-value] confirming the robustness of findings.
Conclusions:
The survival benefit of cTRT established in the chemotherapy era is preserved in the immunotherapy era, with higher radiation doses potentially improving PFS and GLR emerging as a potential prognostic biomarker, warranting prospective validation.
