ArticleClinical and translational radiation oncology2026
Timing, fractionation, and dose of thoracic radiotherapy in patients with extensive-stage small cell lung cancer undergoing first-line Chemo-Immunotherapy.
Article in Clinical and translational radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: This study investigates the optimal timing, fractionation, and dose of thoracic radiotherapy (RT) in extensive-stage small cell lung cancer (ES-SCLC) patients responsive to first-line Chemo-Immunotherapy (CIT), and evaluates efficacy and safety. Materials and methods: In this multicenter retrospective analysis, 280 ES-SCLC patients receiving both CIT and TRT between January 2020 and July 2024 were included. Patients were stratified by TRT timing into Concurrent Chemo-Immuno-Radiotherapy (CCIRT, during CIT) or Sequential CIRT (SCIRT, after CIT) groups. We also evaluated the differences among various prescribed radiation doses and fractionation regimens. To avoid selection bias, we conducted Propensity Score Matching (PSM) for patients. Overall survival (OS), progression-free survival (PFS), and treatment-related adverse events (TRAEs) were assessed and compared. Results: The median PFS and OS in the study were 8.7 months and 20.6 months, respectively. The SCIRT group demonstrated superior PFS (p = 0.008) and OS (p = 0.048) compared with the CCIRT group, and additionally with a lower incidence of TRAEs. In the CCIRT group, a low time-corrected biological effective dose (tBED) (≤50 Gy) was associated with better OS (p = 0.028) and PFS (p = 0.014). Sex, KPS, tBED, brain metastasis status, and other indicators were independent influencing factors for TRAEs. Age, KPS, tBED, and distant metastasis status were independent prognostic factors. Conclusion: Based on the efficacy and safety profile, sequential TRT after first-line chemoimmunotherapy is superior to concurrent administration. The exploratory conclusions regarding the optimal dose and fractionation regimen require confirmation through further research.
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