2401 - Individual Participant Data Meta-Analysis (IPDMA) and Systematic Review of Radical Radiotherapy in Oligometastatic Non Small Cell Lung Carcinoma (NSCLC)
Presenter(s)
A. K. K. Kondeti1,2, K. Tiwari3, M. A. Shamim3, N. Dutt3, P. Kumar3, I. Yadav3, R. Dodiya3, P. Dwivedi3, S. Singh3, and S. B. Varthya3; 1All India Institute of Medical Sciences, Mangalagiri, VIJAYAWADA, Andhra Pra, India, 2All India Institute of Medical Sciences (AIIMS), Mangalagiri, Mangalagiri, India, 3AIIMS, Jodhpur, Jodhpur, India
Purpose/Objective(s): The role of radical radiotherapy in oligometastatic non-small cell lung cancer (NSCLC) is rapidly evolving but has shown mixed results. Hence, the objective of this study is to provide updated, robust, and interpretable estimates on the comparison of add-on radical radiotherapy versus standard therapy alone in oligometastatic NSCLC.
Materials/Methods: In this systematic review and individual participant data (IPD) meta-analysis, we screened four databases i.e, Medline, Embase, Scopus and Cochrane CENTRAL, until 2024/08/06 for randomized controlled trials (RCTs) comparing add-on radical radiotherapy versus systemic therapy alone in oligometastatic NSCLC furnishing data on overall survival (OS), progression-free survival (PFS), or safety. We retrieved IPD from survival curves of published reports and used one stage IPD meta-analysis. We also estimated the more clinically intuitive restricted mean survival time difference (RMSTD). We assessed between-study heterogeneity using the median hazard ratio (MHR). We rated the evidence certainty using the GRADE framework. Protocol: PROSPERO (CRD42024576829).
Results: We screened 571 records to include nine RCTs (mostly at low risk of bias) with 712 participants (338 males), using radiotherapy as radical local therapy. Add-on radical radiotherapy improved OS by 40% [Hazard ratio: 0.60, 95% CI 0.48-0.75; high certainty of evidence]. Between-trial heterogeneity does not affect the results, only leading to a 4% difference [MHR 1.04]. Add-on radical radiotherapy leads to longer OS by 0.33 months (0.12-0.54), 1.97 months (0.26-3.68), 3.95 months (1.19-6.71), and 7.24 months (3.81-10.67) over one, two, three, and four years. Radical radiotherapy was well tolerated with no major safety concerns.
Conclusion: Add-on radical radiotherapy – chiefly stereotactic radiotherapy – is beneficial in oligometastatic NSCLC. Future studies may address the role of additional PD-L1 expression and the related immunotherapy in this group of patients.