Role of radiotherapy in extensive-stage small cell lung cancer after durvalumab-based immunochemotherapy: A retrospective study.

IF 7.3 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Chinese Medical Journal Pub Date : 2025-09-05 Epub Date: 2024-09-23 DOI:10.1097/CM9.0000000000003283

Lingjuan Chen, Yi Kong, Fan Tong, Ruiguang Zhang, Peng Ding, Sheng Zhang, Ye Wang, Rui Zhou, Xingxiang Pu, Bolin Chen, Fei Liang, Qiaoyun Tan, Yu Xu, Lin Wu, Xiaorong Dong

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引用次数: 0

Abstract

Background: The purpose of this study was to evaluate the safety and efficacy of subsequent radiotherapy (RT) following first-line treatment with durvalumab plus chemotherapy in patients with extensive-stage small cell lung cancer (ES-SCLC).

Methods: A total of 122 patients with ES-SCLC from three hospitals during July 2019 to December 2021 were retrospectively analyzed. Inverse probability of treatment weighting (IPTW) analysis was performed to address potential confounding factors. The primary focus of our evaluation was to assess the impact of RT on progression-free survival (PFS) and overall survival (OS).

Results: After IPTW analysis, 49 patients received durvalumab plus platinum-etoposide (EP) chemotherapy followed by RT (Durva + EP + RT) and 72 patients received immunochemotherapy (Durva + EP). The median OS was 17.2 months vs . 12.3 months (hazard ratio [HR]: 0.38, 95% confidence interval [CI]: 0.17-0.85, P = 0.020), and the median PFS was 8.9 months vs . 5.9 months (HR: 0.56, 95% CI: 0.32-0.97, P = 0.030) in Durva + EP + RT and Durva + EP groups, respectively. Thoracic radiation therapy (TRT) resulted in longer OS (17.2 months vs . 14.7 months) and PFS (9.1 months vs . 7.2 months) compared to RT directed to other metastatic sites. Among patients with oligo-metastasis, RT also showed significant benefits, with a median OS of 17.4 months vs . 13.7 months and median PFS of 9.8 months vs . 5.9 months compared to no RT. Continuous durvalumab treatment beyond progression (TBP) prolonged OS compared to patients without TBP, in both the Durva + EP + RT (NA vs . 15.8 months, HR: 0.48, 95% CI: 0.14-1.63, P = 0.238) and Durva + EP groups (12.3 months vs . 4.3 months, HR: 0.29, 95% CI: 0.10-0.81, P = 0.018). Grade 3 or 4 adverse events occurred in 13 (26.5%) and 13 (18.1%) patients, respectively, in the two groups; pneumonitis was mostly low-grade.

Conclusion: Addition of RT after first-line immunochemotherapy significantly improved survival outcomes with manageable toxicity in ES-SCLC.

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基于杜伐单抗的免疫化疗后放疗在广泛期小细胞肺癌中的作用：回顾性研究。

研究背景本研究的目的是评估广泛期小细胞肺癌（ES-SCLC）患者在接受durvalumab加化疗一线治疗后接受后续放疗（RT）的安全性和有效性：回顾性分析了2019年7月至2021年12月期间三家医院共122例ES-SCLC患者。为解决潜在的混杂因素，进行了逆治疗概率加权（IPTW）分析。我们评估的主要重点是评估 RT 对无进展生存期（PFS）和总生存期（OS）的影响：IPTW分析后，49例患者接受了杜瓦单抗+铂-依托泊苷（EP）化疗，然后进行RT（Durva + EP + RT），72例患者接受了免疫化疗（Durva + EP）。Durva + EP + RT组和Durva + EP组的中位OS分别为17.2个月和12.3个月（危险比[HR]：0.38，95% CI：0.17-0.85，P = 0.020），中位PFS分别为8.9个月和5.9个月（HR：0.56，95% CI：0.32-0.97，P = 0.030）。与针对其他转移部位的RT相比，胸腔放疗（TRT）可获得更长的OS（17.2个月 vs. 14.7个月）和PFS（9.1个月 vs. 7.2个月）。在寡转移患者中，RT也有显著疗效，与不进行RT相比，中位OS为17.4个月对13.7个月，中位PFS为9.8个月对5.9个月。在Durva + EP + RT组（NA vs. 15.8个月，HR：0.48，95% CI：0.14-1.63，P = 0.238）和Durva + EP组（12.3个月 vs. 4.3个月，HR：0.29，95% CI：0.10-0.81，P = 0.018），与未接受TBP治疗的患者相比，进展后持续接受durvalumab治疗可延长患者的OS。两组患者中分别有13例（26.5%）和13例（18.1%）出现3级或4级不良反应；肺炎多为低度不良反应：结论：在一线免疫化疗后加用RT可显著改善ES-SCLC患者的生存预后，且毒性可控。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Chinese Medical Journal 医学-医学：内科

CiteScore

9.80

自引率

4.90%

发文量

19245

审稿时长

6 months

期刊介绍： The Chinese Medical Journal (CMJ) is published semimonthly in English by the Chinese Medical Association, and is a peer reviewed general medical journal for all doctors, researchers, and health workers regardless of their medical specialty or type of employment. Established in 1887, it is the oldest medical periodical in China and is distributed worldwide. The journal functions as a window into China’s medical sciences and reflects the advances and progress in China’s medical sciences and technology. It serves the objective of international academic exchange. The journal includes Original Articles, Editorial, Review Articles, Medical Progress, Brief Reports, Case Reports, Viewpoint, Clinical Exchange, Letter,and News,etc. CMJ is abstracted or indexed in many databases including Biological Abstracts, Chemical Abstracts, Index Medicus/Medline, Science Citation Index (SCI), Current Contents, Cancerlit, Health Plan & Administration, Embase, Social Scisearch, Aidsline, Toxline, Biocommercial Abstracts, Arts and Humanities Search, Nuclear Science Abstracts, Water Resources Abstracts, Cab Abstracts, Occupation Safety & Health, etc. In 2007, the impact factor of the journal by SCI is 0.636, and the total citation is 2315.