Consolidative Thoracic Radiotherapy Improves Survival in Extensive-Stage Small Cell Lung Cancer After First-Line Chemoimmunotherapy
Key Clinical Takeaways
- Design/Population: In a retrospective analysis 100 patients with extensive-stage small cell lung cancer (ES-SCLC) who received first-line platinum-based chemoimmunotherapy were evaluated for the impact of consolidative thoracic radiotherapy (cTRT) on survival outcomes. Patients were grouped by receipt of cTRT after systemic response.
- Key Outcomes: Median OS was 26 months with cTRT vs 17 months without (P = .006), and median PFS was 10 vs 6 months (P = .005). cTRT independently predicted improved OS (HR 0.48; P = .04). Locoregional progression at 1 year was 22.3% vs 55.4% (P < .001). Grade 3 esophagitis occurred in 3 patients; grade 1/2 pneumonitis in 5.
- Clinical Relevance: cTRT following first-line chemoimmunotherapy significantly improved OS, PFS, and local control with manageable toxicity, supporting its role as a consolidative strategy in ES-SCLC.
According to results from a retrospective analysis, administration of consolidative thoracic radiotherapy (cTRT) following first-line chemoimmunotherapy demonstrated promising efficacy and safety among patients with extensive-stage small cell lung cancer (ES-SCLC).
In this study, researchers analyzed data from 100 patients who received first-line platinum-based chemotherapy plus immunotherapy. Based on response following systemic therapy, consolidative thoracic radiotherapy was recommended, and patients were divided into cohorts according to treatment received.
Primary end points included overall survival (OS) and progression-free survival (PFS). Univariate and multivariate analyses were used to identify prognostic factors for OS, and the Fine-Gray competing risks model was applied to calculate the cumulative incidence of locoregional progression.
At analysis, median OS was 26 months in patients who received cTRT and 17 months in those who did not (P = .006). Median PFS was 10 months and 6 months, respectively (P = .005). Multivariate analysis identified cTRT as the only independent prognostic factor associated with improved OS (hazard ratio [HR] 0.48; P = .04). The 1-year cumulative incidence of locoregional progression was 22.3% among patients who received cTRT and 55.4% among those who did not (P <.001). Among patients who received cTRT, grade 3 radiation esophagitis occurred in 3 patients, and grade 1/2 radiation pneumonitis occurred in 5 patients.
As the study authors concluded, consolidative thoracic radiotherapy “holds potential benefits for ES-SCLC patients responding to first-line chemoimmunotherapy.”
Source:
Zhang C, Wang W, Bi N, et al. Efficacy and safety of consolidative thoracic radiotherapy for extensive-stage small cell lung cancer in the era of immunotherapy: A real-world study. Lung Cancer. Published online September 17, 2025. doi:10.1016/j.lungcan.2025.108758
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