Optimal Initial Time Point of Local Radiotherapy for Unresectable Lung Adenocarcinoma: A Retrospective Analysis on Overall Arrangement of Local Radiotherapy in Advanced Lung Adenocarcinoma

Abstract

Local radiotherapy (LRT) is reported to be of survival benefit for advanced non-small cell lung cancer (NSCLC) in accumulating evidence, but research on the optimal initial time point remains scarce. This IRB-approved retrospective analysis identified patients diagnosed with stage IIIb–IV unresectable lung adenocarcinoma who initiated front-line LRT at our institution between 2017 and 2020. The receiver operating characteristic (ROC) curve analyses were used to cut off the initial time of LRT (before and beyond 53 days). Patients were divided into two groups: one early to initiate radiotherapy group (≤53 days, EAR group) and one deferred radiotherapy group (>53 days, DEF group). The Kaplan–Meier method was used to estimate time-to-event endpoints; the Cox proportional hazard model was used to find out predictors of progression-free survival (PFS) and overall survival (OS). A total of 265 patients with a median age of 57 were enrolled. The median follow-up time was 26.4 months (ranging from 2.2 to 69.7 months). The mOS was 38.6 months and mPFS was 12.7 months. Age >60, bone and brain metastases, multisite metastases, and EGFR 19 mutation were independent predictors associated with OS. Early initiation of local radiotherapy within 53 days after diagnosis resulted in better PFS, but not in OS. A better OS was observed in patients with bone metastasis who underwent local radiotherapy initiated within 53 days.

Local Consolidative Therapy May Have Prominent Clinical Efficacy in Patients with EGFR-Mutant Advanced Lung Adenocarcinoma Treated with First-Line Afatinib

“…In addition, radiotherapy may produce an abscopal effect on metastatic tumors [ 34 ]. Local radiotherapy delivered to the primary NSCLC tumor can include traditional intensity-modulated radiation therapy (IMRT) [ 35 ] or stereotactic ablative radiotherapy (SABR) [ 25 , 26 ]. Using IMRT as LCT in the treatment of advanced NSCLC has been associated with a survival benefit, and Li et al reported on IMRT use in 265 patients, with a median PFS and OS of 12.7 and 38.6 months, respectively [ 35 ].…”

“…Local radiotherapy delivered to the primary NSCLC tumor can include traditional intensity-modulated radiation therapy (IMRT) [ 35 ] or stereotactic ablative radiotherapy (SABR) [ 25 , 26 ]. Using IMRT as LCT in the treatment of advanced NSCLC has been associated with a survival benefit, and Li et al reported on IMRT use in 265 patients, with a median PFS and OS of 12.7 and 38.6 months, respectively [ 35 ]. In addition, SABR applied to the primary lung mass has shown efficacy in treating patients with oligometastatic NSCLC.…”

Progress in the treatment of lung adenocarcinoma by integrated traditional Chinese and Western medicine

“…This necessitates systemic treatments, which can limit the applicability of surgical methods. Depending on disease type and stage, appropriate radiotherapy methods can be selected, and conventional chemotherapy is employed in various contexts, including neoadjuvant chemotherapy, postoperative chemotherapy, and combined radiotherapy and chemotherapy ( 22 ). Research has demonstrated that platinum-based adjuvant chemotherapy significantly enhances the survival rates of patients with completely resected stage II or stage III lung adenocarcinoma, particularly when tailored to individual patients through biomarker screening ( 23 ).…”

“…Radiotherapy is a crucial approach in cancer treatment, utilizing radiation to target and treat tumor lesions. It is known for its localized application and wide range of therapeutic applications, offering targeted treatment options ( 22 ). However, the side effects of radiotherapy should not be ignored.…”