Exploring Thoracic Radiotherapy in Metastatic NSCLC: A Retrospective Review in the Era of Immunotherapy and Targeted Therapies

Mansoorian S, Lehmann J, Käsmann L, Gaus R, Richlitzki C, Kravutske H, Putz F, Schmidt-Hegemann NS, Reinmuth N, Tufman A, Dinkel J, Sheikh G, Belka C, Eze C (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Clinical Lung Cancer Elsevier

DOI: 10.1016/j.cllc.2026.02.009

Abstract

Background Lung cancer remains the leading cause of cancer-related deaths worldwide. Advances in immunotherapy and targeted therapies have improved survival in stage IV non–small cell lung cancer (NSCLC), highlighting the importance of local control of the primary tumor. Hypofractionated radiotherapy (hypo-RT), delivering high biologically effective doses (BEDs) over shorter durations, shows potential in locally advanced NSCLC but is underexplored in metastatic settings. Purpose This retrospective study evaluated 104 patients with stage IV NSCLC who received hypo-RT to the primary tumor at LMU Munich between December 2013 and June 2022. The primary endpoints were overall survival (OS) and progression-free survival (PFS), while the secondary endpoints included local failure-free survival, regional failure-free survival, distant failure-free survival, and the identification of prognostic factors. Findings Median OS and PFS were 15.4 months (95% confidence interval [CI]: 10.5-24.4) and 3.9 months (95% CI, 3.2-6.2), respectively. Significant predictors of OS included Eastern Cooperative Oncology Group performance status >1 (hazard ratio [HR]: 3.260, P = .0003), male sex (HR: 1.869, P = .038), metastases in >2 organ systems (HR: 2.014, P = .022), and BED < 58.5 Gy (HR: 2.117, P = .017). Predictors of PFS included smoking history <30 pack-years (HR: 1.912, P = .003) and BED < 58.5 Gy (HR: 1.816, P = .025). Conclusion Hypo-RT is effective and feasible in metastatic NSCLC, with higher BEDs improving survival. Findings highlight the importance of personalized treatment strategies integrating clinical, molecular, and therapeutic factors.

Authors with CRIS profile

Florian Putz Department of Radiation Oncology

Involved external institutions

Klinikum der Universität München (LMU Klinikum) DE Germany (DE) Technische Universität München (TUM) DE Germany (DE) Deutsches Krebsforschungszentrum (DKFZ) DE Germany (DE) Deutsches Zentrum für Lungenforschung e.V. (DZL) DE Germany (DE)

How to cite

APA:

Mansoorian, S., Lehmann, J., Käsmann, L., Gaus, R., Richlitzki, C., Kravutske, H.,... Eze, C. (2026). Exploring Thoracic Radiotherapy in Metastatic NSCLC: A Retrospective Review in the Era of Immunotherapy and Targeted Therapies. Clinical Lung Cancer. https://doi.org/10.1016/j.cllc.2026.02.009

MLA:

Mansoorian, Sina, et al. "Exploring Thoracic Radiotherapy in Metastatic NSCLC: A Retrospective Review in the Era of Immunotherapy and Targeted Therapies." Clinical Lung Cancer (2026).

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