Association of salvage radiotherapy with survival outcomes in extracranial oligoprogression after first-line therapy for extensive-stage small-cell lung cancer: a multicenter retrospective cohort study.

Authors

Jiatong Li, Shuting Han, Xiaoyang Zhai, Xuwei Cai, Lujun Zhao, Xuquan Jing, Xiaoyong Tang, Hui Zhu, Jinming Yu

Published in

Therapeutic advances in medical oncology. Volume 18. Pages 17588359261469149. Epub Jul 25, 2026.

Abstract

While first-line systemic therapy is the standard of care for extensive-stage small-cell lung cancer (ES-SCLC), therapeutic failure remains nearly universal, with survival heavily dictated by progression patterns. Extracranial oligoprogression represents a distinct treatment failure phenotype lacking standardized management.
To evaluate the efficacy and survival impact of salvage radiotherapy (RT) in ES-SCLC patients experiencing extracranial oligoprogression after first-line therapy.
A multicenter retrospective cohort study.
We retrospectively enrolled patients with ES-SCLC developing extracranial oligoprogression after first-line therapy from three cancer centers in China between January 2020 and March 2025. Patients were stratified into RT and non-RT groups based on the administration of radiotherapy post-progression. Propensity score matching (PSM) was employed to balance baseline characteristics. Primary endpoints included second-line overall survival (OS2) and progression-free survival (PFS2), estimated via Kaplan-Meier analysis and compared using log-rank tests.
A total of 232 Chinese patients experienced extracranial oligoprogression, with a median time to progression of 6.1 months (range: 1.0-37.8 months). In the matched cohort, RT significantly prolonged median PFS2 (6.1 vs 3.3 months; p = 0.007) and OS2 (13.4 vs 8.4 months; p = 0.029). Subgroup analyses revealed more pronounced survival benefits in patients characterized by prior immunotherapy, progression of existing lesions, intrathoracic progression, and delayed progression (PFS1 >6 months). Furthermore, among patients who received RT, continuation of first-line systemic therapy was associated with superior PFS2 (9.6 vs 5.4 months; p = 0.017) and OS2 (14.4 vs 13.4 months; p = 0.030) compared with switching to an alternative systemic therapy.
This multicenter study is one of the first to indicate that radiotherapy is associated with a survival benefit in patients with ES-SCLC and extracranial oligoprogression. Notably, combining radiotherapy with continuation of first-line systemic therapy offered greater clinical utility than switching to an alternative systemic therapy.

PMID:
42504316
Bibliographic data and abstract were imported from PubMed on 27 Jul 2026.

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