Local ablative therapy plus systemic treatment versus systemic therapy alone in oligometastatic non-small cell lung cancer: a systematic review and meta-analysis of randomized trials.

Authors

Yaocan Xu, Yingyun Liang, Weiwei Gao, Xiaomin Yang, Fengfei Qin, Zheng Tao, Xiaoping Li, Kequan Chen, Yong Liang

Published in

International journal of clinical oncology. Oct 28, 2026. Epub Oct 28, 2026.

Abstract

This study aimed to evaluate the role of adding local ablative therapy (LAT) to standard systemic therapy (SST) in patients with oligometastatic non-small cell lung cancer (NSCLC).
We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) evaluating LAT in oligometastatic NSCLC. The primary outcomes were progression-free survival (PFS) and overall survival (OS). Pooled hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Sixteen RCTs (1,343 patients) were included. LAT significantly improved PFS (HR 0.63, 95%CI 0.55-0.72) and OS (HR 0.68, 95%CI 0.58-0.81). In EGFR‑mutant patients, LAT improved PFS (HR 0.54, 95%CI 0.44-0.66) and OS (HR 0.52, 95%CI 0.40-0.67), with consistent benefits across mutation subtypes, TKI generations, and LAT timing. In chemotherapy and/or immunotherapy recipients, LAT improved PFS (HR 0.69, 95%CI 0.56-0.86) but not OS (HR 0.83, 95%CI 0.64-1.07). No benefit was seen with LAT added to immunotherapy alone (PFS: HR 0.86, 95% CI 0.66-1.13; OS: HR 0.87, 95%CI 0.55-1.36); however, in PD‑L1 ≥1% patients, LAT significantly improved PFS (HR 0.34, 95%CI 0.12-0.96). In the chemotherapy‑alone subgroup, LAT did not improve PFS (HR 0.49, 95%CI 0.23-1.06) or OS (HR 1.17, 95%CI 0.78-1.75), but significantly prolonged PFS in patients with ≤3 metastases (HR 0.34, 95%CI 0.21-0.57). By brain metastasis status, LAT improved PFS in patients without brain metastases (HR 0.54, 95%CI 0.37-0.78), with a trend toward OS benefit (HR 0.69, 95%CI 0.48-1.00), but not in those with asymptomatic/minimally symptomatic lesions (PFS: HR 0.67, 95%CI 0.43-1.07; OS: HR 0.89, 95%CI 0.60-1.32). LAT increased grade ≥3 AEs (RR 1.62, 95%CI 1.10-2.39) and pneumonitis (RR 6.28, 95%CI 2.02-19.35).
Adding LAT to SST significantly improves survival in oligometastatic NSCLC, particularly in EGFR‑mutant patients receiving EGFR‑TKIs, in PD‑L1 ≥1% patients receiving immunotherapy, in those with ≤3 metastases receiving chemotherapy, and in patients without brain metastases. These findings support a biomarker‑ and burden‑stratified approach to integrating LAT.

PMID:
42955614
Bibliographic data and abstract were imported from PubMed on 30 Oct 2026.

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