Single-center retrospective study of radiotherapy versus surgical resection following neoadjuvant therapy for potentially resectable stage III NSCLC

Neoadjuvant chemoimmunotherapy followed by surgery is recommended for resectable non-small cell lung cancer (NSCLC). However, a considerable proportion of patients refuse surgery. A retrospective study at the Chinese Academy of Medical Sciences & Peking Union Medical College (Beijing) compared outcomes of patients with potentiall resectable stage III NSCLC who received neoadjuvant chemoimmunotherapy followed by either surgery (n=125) or radiotherapy (n=50). In unadjusted analysis, the progression-free survival (PFS) was inferior in the radiotherapy group (HR 2.23; p=0.008). However, after 1:1 propensity score matching (two groups of 40 patients), the median PFS was 30.8 months in the radiotherapy group and not reached in the surgery group (HR 1.46; p=0.390), with 12- and 24-month PFS rate of 90.4% and 69.0% in the radiotherapy group compared with 94.1% and 73.9% in the surgery group, respectively. No grade 5 treatment-related adverse events (TRAEs) were observed. Grade 3 or 4 TRAEs occurred in 62.5% of patients in the radiotherapy group and 55.0% in the surgery group. The authors conclude that radiotherapy may be a viable alternative to surgery in patients with resectable NSCLC after neoadjuvant chemoimmunotherapy.