| Zhang Yaowen,Wen Jingyuan,Wang Chenyu,et al.The role of radiotherapy in combined immunotherapy and chemotherapy as first-line treatment for oligometastatic non-small cell lung cancer[J].Chinese Journal of Radiological Medicine and Protection,2025,45(2):91-100 |
| The role of radiotherapy in combined immunotherapy and chemotherapy as first-line treatment for oligometastatic non-small cell lung cancer |
| Received:September 02, 2024 |
| DOI：10.3760/cma.j.cn112271-20240902-00332 |
| KeyWords:Cancer Non-small cell lung cancer Oligometastasis Radiotherapy Immunochemotherapy First-line treatment Prognosis |
| FundProject: |
| Author Name | Affiliation | E-mail | | Zhang Yaowen | Department of Radiation Oncology, Anyang Tumor Hospital, Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Anyang 455000, China | | | Wen Jingyuan | Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China | | | Wang Chenyu | Department of Radiation Oncology, Anyang Tumor Hospital, Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Anyang 455000, China | | | Cheng Xinyu | Department of Radiation Oncology, Anyang Tumor Hospital, Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Anyang 455000, China | | | Zhang Heming | Department of Radiation Oncology, Anyang Tumor Hospital, Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Anyang 455000, China | | | Jin Linzhi | Department of Radiation Oncology, Anyang Tumor Hospital, Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Anyang 455000, China | | | Ren Runchuan | Department of Radiation Oncology, Anyang Tumor Hospital, Affiliated Anyang Tumor Hospital of Henan University of Science and Technology, Anyang 455000, China | | | Zhao Xiaohan | Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China | | | Shen Wenbin | Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China | wbshen1979@sina.com |
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| Abstract:: |
| Objective To evaluate the therapeutic value of radiotherapy in combined immunotherapy and chemotherapy as first-line treatment for patients with oligometastatic non-small cell lung cancer (NSCLC). Methods A retrospective analysis was conducted on data from 195 NSCLC patients who lacked epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) mutations and were treated at the Anyang Tumor Hospital and the Fourth Hospital of Hebei Medical University from January 2019 to December 2021. These patients consisted of 166 male and 29 female cases, aged from 28 to 85 years, with an average age of (61.4 ±9.3) years. These patients were divided into two groups, with each group receiving the radiotherapy and combined immunotherapy and chemotherapy (the radiotherapy and combination group, n = 60) and combined immunotherapy and chemotherapy only (the combination group, n = 135). Then, propensity score matching (PSM) was performed to analyze the differences in prognosis between both groups before and after PSM, as well as the short-term efficacy and adverse reactions after PSM. Results For the 195 NSCLC patients, the median follow-up time was 31.8 months, with median overall survival (OS) and median progression-free survival (PFS) recorded at 23.8 months and 9.2 months, respectively. The radiotherapy and combination group exhibited enhanced 1-, 2-, and 3-year survival rates of 78.5%, 55.9%, and 45.1%, respectively, significantly higher than the combination group (48.3%, 35.6%, and 26.6%, respectively, χ2 = 14.65, P < 0.001). Similarly, the radiotherapy and combination group displayed 1-, 2-, and 3-year PFS rates of 51.9%, 29.5%, and 22.7%, respectively, exceeding those of the combination group (30.0%, 24.5%, and 16.9%, respectively, χ2 = 6.09, P = 0.014). After PSM, the radiotherapy and combination group manifested an objective response rate (ORR) of 60.0% (33/55) and a disease control rate (DCR) of 89.1% (49/55), which were 16.4% (9/55) and 56.4% (31/55), respectively for the combination group. These results suggested that the radiotherapy and combination group demonstrated significantly higher ORR and DCR (χ2 = 22.18, 14.85, P < 0.001). After PSM, the radiotherapy and combination group yielded 1-, 2-, and 3-year survival rates of 70.9%, 52.3%, and 41.9%, respectively, significantly than the combination group (43.6%, 29.8%, and 27.1%, respectively, χ2 = 8.95, P = 0.003). The radiotherapy and combination group exhibited 1-, 2-, and 3-year PFS rates of 47.3%, 27.3%, and 18.7%, respectively, significantly higher than the combination group (23.6%, 17.6%, and 15.4%, respectively, χ2 = 6.71, P = 0.010). Multivariate Cox regression analysis revealed that independent factors affecting OS included clinical stage, treatment regimen, number of immunotherapy cycles, and treatment efficacy (HR = 1.88, 2.11, 0.23, 1.79, P < 0.05). Similarly, independent factors affecting PFS consisted of treatment regimen, number of immunotherapy cycles, and treatment efficacy (HR = 1.62, 0.37, 3.42, P <0.05). There were no statistical differences in the incidence of grade ≥ 2 bone marrow suppression (18.2% vs. 12.7%) and grade ≥ 2 pneumonia (21.8% vs. 14.5%) between both groups (P > 0.05). Conclusions Introducing radiotherapy into combined immunotherapy and chemotherapy as first-line treatment for oligometastatic NSCLC can optimize both local and systemic disease control and significantly improve patient prognosis without increasing treatment-related adverse reactions. |
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