SynthesisFrontiers in immunology2025
Enhanced efficacy of lung cancer treatment with radiotherapy and immune checkpoint inhibitors without increased pneumonia risk: a systematic review and meta-analysis of randomized controlled trials.
Synthesis in Frontiers in immunology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The impact of comorbid type 2 diabetes on survival outcomes in patients with solid tumors treated with immune checkpoint inhibitors: a meta-analysis focusing on lung cancer.Frontiers in endocrinology · 2026Pooled it
- Adapting federated radiomics models for radiation pneumonitis prediction in patients receiving thoracic radiotherapy with immunotherapy.Frontiers in immunology · 2026Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Objective: Combined modality treatment with chemotherapy, radiotherapy, and immunotherapy is a crucial therapeutic approach for lung cancer. However, controversies still exist regarding radiation doses, treatment regimens, and the risk of pneumonitis. This study aimed to conduct a comprehensive meta-analysis and in-depth subgroup analyses based on randomized controlled trials (RCTs) involving lung cancer patients undergoing radiotherapy to assess whether its combination with immunotherapy is effective and safe. Methods: We systematically searched PubMed, Cochrane Central, Embase, and major conferences for randomized trials evaluating immune checkpoint inhibitors (ICIs) plus radiotherapy in lung cancer. The outcomes included progression-free survival (PFS), overall survival (OS), and the incidence of adverse reactions, particularly focusing on pneumonitis/pneumonia. Subgroup analyses were performed based on radiotherapy modalities, the timing of ICIs treatment, tumor stage, pathological type, and types of ICIs. Results: Fifteen trials were included in this analysis. The addition of ICIs to radiotherapy or chemoradiotherapy significantly improved PFS (HR = 0.76, 95% CI 0.70-0.83) and OS (HR = 0.83, 95% CI 0.75-0.92). In subgroup analyses, stereotactic body radiotherapy (SBRT) (HR = 0.38, 95% CI 0.19-0.75) and hypo-fractionated radiotherapy (Hypo-RT) (HR = 0.49, 95% CI 0.31-0.79) were associated with improved PFS. Consolidation ICIs treatment improved OS (HR = 0.68, 95% CI 0.59-0.79), while concurrent ICIs had no significant effect (HR = 1.06, 95% CI 0.87-1.28). In terms of tumor stage, Stage I NSCLC patients (HR = 0.38, 95% CI 0.19-0.75) showed significant PFS improvement with ICIs. Both PD-1 (HR = 0.39, 95% CI 0.22-0.69) and PD-L1 (HR = 0.75, 95% CI 0.64-0.87) inhibitors were linked to improved PFS in irradiated lung cancer patients, and PD-L1 also enhanced OS (HR = 0.82, 95% CI 0.68-0.99). The addition of ICIs increased the risk of any-grade pneumonitis/pneumonia (RR = 1.27, 95% CI 1.12-1.44) but did not elevate the risk of severe (grade ≥3) events (RR = 1.12, 95% CI 0.78-1.60). Notably, among patients treated with SBRT, no significant increase was observed in the incidence of pneumonitis of any grade. Conclusions: PD-1/PD-L1 inhibitors combined with radiotherapy especially SBRT can enhance survival outcomes in lung cancer without increasing the risk of severe pneumonitis/pneumonia, supporting their clinically manageable safety profile. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/home, identifier CRD420251140111.
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