Purpose: We conducted the largest multinational review to date evaluating outcomes following radiotherapy for non-small cell lung carcinoma (NSCLC) patients with oligoprogressive disease (OPD) on immune checkpoint inhibitors (ICIs).Methods: Patients with NSCLC irradiated to ≤5 progressive lesions while receiving ICIs between 2010 and 2023 were identified. We evaluated predictors of local control (LC), progression-free survival (PFS), and overall survival (OS). Patient demographics, disease characteristics, and survival were analyzed using the Wilcoxon test, Kaplan-Meier methods, and uni-/multivariate Cox models.Results: Out of 1178 treated patients, 103 eligible ones were included. The median OPD lesion was 1; the most common site was the lung (n = 33). The median LC of irradiated OPD lesions was not reached. Median PFS and OS were 6.90 (5.75–12.91) and 23.46 (17.54–37.16) months, respectively. Patient demographics, tumor pathological factors, number of OPD lesions, cumulative tumor volume, radiation modality, and OPD response to prior ICIs before radiation were not associated with these three outcomes. However, LC was associated with intermediate/high radiation doses (p= 0.005) and local response to radiation (p= 0.007). Improved PFS was associated with visceral OPD sites following radiation (p= 0.01). A favorable OS was associated with intermediate/high radiation doses (p= 0.01), local response to radiation (p= 0.006), and duration of last ICI before OPD (p= 0.03).Conclusions: Promising outcomes were observed with ICI and radiation for visceral OPD at intermediate/high doses. Prolonged ICI use before OPD and local response to radiotherapy improved survival. These data can contribute towards guidance of multidisciplinary clinical decision-making for managing OPD in NSCLC patients receiving ICIs.
目的：我们开展了迄今为止规模最大的跨国研究，评估免疫检查点抑制剂（ICIs）治疗期间出现寡进展性疾病（OPD）的非小细胞肺癌（NSCLC）患者接受放疗后的疗效。 方法：本研究纳入了2010年至2023年间在接受ICIs治疗期间，对≤5个进展病灶进行放疗的NSCLC患者。我们评估了局部控制率（LC）、无进展生存期（PFS）和总生存期（OS）的预测因素。采用Wilcoxon检验、Kaplan-Meier法以及单变量/多变量Cox模型分析患者人口统计学特征、疾病特征和生存数据。 结果：在1178例接受治疗的患者中，最终纳入103例符合条件的患者。中位OPD病灶数为1个；最常见的转移部位是肺部（n=33）。放疗后OPD病灶的中位局部控制时间未达到。中位PFS和OS分别为6.90个月（95% CI: 5.75–12.91）和23.46个月（95% CI: 17.54–37.16）。患者人口统计学特征、肿瘤病理学因素、OPD病灶数量、累积肿瘤体积、放疗方式以及放疗前OPD对既往ICIs的反应均与上述三项结局无显著关联。然而，局部控制率与中/高放疗剂量（p=0.005）及对放疗的局部反应（p=0.007）相关。改善的无进展生存期与放疗后内脏部位OPD病灶相关（p=0.01）。良好的总生存期则与中/高放疗剂量（p=0.01）、对放疗的局部反应（p=0.006）以及OPD发生前末次ICI的持续使用时间（p=0.03）相关。 结论：对于内脏部位OPD，采用中/高剂量放疗联合ICIs治疗显示出良好的疗效。OPD发生前长期使用ICI以及对放疗产生局部反应均能改善患者生存。这些数据可为接受ICIs治疗的NSCLC患者OPD的多学科临床决策管理提供指导。
肿瘤(癌症)患者之家