Work

Efficacy of whole-brain radiotherapy with or without simultaneous integrated boost in non-small cell lung cancer with brain metastases: a retrospective analysis

Year: 2026

Type: article

Abstract: Background Whole-brain radiotherapy (WBRT) remains a cornerstone in the management of brain metastases (BMs) from non-small cell lung cancer (NSCLC), and WBRT with simultaneous integrated boost (WBRT-SIB) emerges as a promising strategy that aims to improve local tumor control through dose escalation while maintaining the coverage of subclinical disease offered by WBRT in theory. However, current evidence regarding the efficacy of WBRT-SIB remains inconclusive. This study aimed to compare the intracranial efficacy of WBRT and WBRT-SIB in NSCLC patients with BMs. Methods Clinical data from 119 patients with NSCLC-BM treated between 2019 and 2025 were retrospectively analyzed. Local progression-free survival (local PFS) was the primary endpoint, while distant PFS and intracranial PFS (iPFS) were secondary endpoints. Propensity score matching (PSM) was performed to balance baseline characteristics. Kaplan–Meier and Cox regression analyses were applied to identify prognostic factors. Results No significant differences were observed in local PFS, distant PFS, or iPFS between the WBRT and WBRT-SIB groups, both before and after PSM (all p > 0.05). Subgroup analysis revealed that patients with fewer than eight BMs who received WBRT-SIB achieved significantly longer local PFS compared with those treated with WBRT ( p = 0.043), along with a trend toward improved iPFS that did not reach statistical significance ( p = 0.066). Furthermore, anti-angiogenic therapy showed a trend as a protective factor for local PFS without reaching statistical significance ( p = 0.086). Conclusion WBRT-SIB provided comparable overall intracranial control to conventional WBRT but achieved superior local tumor control in patients with limited brain metastases (< 8 lesions). These findings support WBRT-SIB as a promising option for selected NSCLC-BM patients, warranting validation in prospective studies.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2025.1733289