Journal Article

Evaluation of the optimal timing of radiotherapy in EGFR-Mutant oligometastatic NSCLC through a retrospective analysis of treatment sequences and survival outcomes

Wang, Lan, Gao, Wen, Zhang, Bi-Yuan, Wang, Qi, Zhang, Meng, Guo, Tian-Hui, Wang, Hai-Ji

2025

Overview

Non-small cell lung cancer (NSCLC) with EGFR mutations presents a unique challenge due to the development of oligometastasis during treatment with first-line tyrosine kinase inhibitors (TKIs). The optimal timing of radiotherapy in EGFR-mutant oligometastatic NSCLC remains debated. This study aims to investigate the timing of radiotherapy in relation to disease progression to optimize treatment outcomes. We conducted a retrospective analysis of stage IIIB-IV EGFR-mutant NSCLC patients who received first-line TKI therapy and developed oligoprogressive disease between January 2019 and October 2024. Two groups were compared: one receiving radiotherapy before disease progression ( n  = 41) and the other post-progression ( n  = 26). The primary outcomes were progression-free survival (PFS1), progression-free survival after radiotherapy (RT-PFS), and the duration of first-line TKI therapy. Statistical analyses were performed using Kaplan-Meier curves and Cox regression. A total of 67 patients were included. The median PFS1 was 13.8 months in the upfront consolidative radiotherapy group versus 9.8 months in the post-progression group ( P  = 0.391). The median duration of first-line TKI therapy was significantly longer in the post-progression radiotherapy group (20.3 months vs. 13.3 months, P  < 0.001). Kaplan-Meier survival analysis showed a significant difference in TKI duration, suggesting delayed radiotherapy improved TKI duration. This retrospective study suggests that the timing of radiotherapy may influence the duration of first-line EGFR-TKI therapy in patients with oligometastatic NSCLC. Administering local therapy at the time of oligoprogression may help prolong TKI benefit without premature treatment escalation. However, given the study’s retrospective design and potential baseline imbalances, these findings should be interpreted with caution and require validation in future prospective trials.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
• Subject: 692/308 / 692/308/409 / 692/4028 / 692/4028/67 / Adult / Aged / Cancer therapies / Carcinoma, Non-Small-Cell Lung - drug therapy / Carcinoma, Non-Small-Cell Lung - genetics / Carcinoma, Non-Small-Cell Lung - mortality / Carcinoma, Non-Small-Cell Lung - radiotherapy / Cell survival / Chemotherapy / China - epidemiology / Clinical trials / EGFR-mutant NSCLC / Epidermal growth factor / Epidermal growth factor receptors / ErbB Receptors - genetics / Female / Gender / Histology / Humanities and Social Sciences / Humans / Lung cancer / Lung Neoplasms - drug therapy / Lung Neoplasms - genetics / Lung Neoplasms - mortality / Lung Neoplasms - radiotherapy / Lymphatic system / Male / Metastasis / Middle Aged / multidisciplinary / Mutants / Mutation / Neoplasm Metastasis / Non-small cell lung carcinoma / Oligometastatic disease / Patients / Radiation therapy / Radiotherapy / Radiotherapy - methods / Radiotherapy - standards / Radiotherapy - statistics & numerical data / Retrospective Studies / Science / Science (multidisciplinary) / Small cell lung carcinoma / Statistical analysis / Survival / Tumors / Tyrosine kinase inhibitors / Tyrosine kinase inhibitors (TKIs) / Tyrosine Kinase Inhibitors - therapeutic use