Efficacy and safety of stereotactic body radiotherapy combined with immune checkpoint inhibitors for non-small cell lung cancer: a systematic review and reconstructed individual patient data meta-analysis
Year: 2026
Type: article
Abstract: Background: Stereotactic body radiotherapy (SBRT) may augment antitumor immunity when combined with immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC), but clinical studies span markedly different disease stages and treatment intents and have produced inconsistent comparative results. We aimed to synthesize the evidence and evaluate efficacy and safety, separating pairwise outcomes from descriptive single-arm outcomes. Methods: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov were searched from inception through August 2026. Pairwise outcomes were synthesized as risk ratios (RRs) or reconstructed survival hazard ratios (HRs) and 95% confidence interval (CI). Single-arm outcomes of SBRT plus ICI were summarized as pooled proportions. Published Kaplan-Meier curves were digitized and reconstructed as individual patient data (IPD). Disease-stage and treatment-setting analyses were prespecified as descriptive because they were based on unadjusted between-study comparisons. Results: Twenty-one studies enrolling 1,096 participants were included. Five comparative studies contributed to at least one pairwise outcome. SBRT plus ICI was not associated with statistically significant improvements in overall survival (OS) (HR 0.81, 95% CI: 0.52-1.25), progression-free survival (PFS) (HR 0.76, 95% CI: 0.53-1.10), or objective response rate (ORR) (RR 1.72, 95% CI: 0.85-3.51). Disease control rate (DCR) favored SBRT plus ICI (RR 1.20, 95% CI: 1.03-1.39), but significance was lost when either of two influential studies was omitted. Pairwise risks of any-grade and grade ≥3 adverse events (AEs) did not differ significantly. In descriptive single-arm analyses, median OS was 36.4 months (95% CI: 29.8-50.9) and median PFS was 14.6 months (95% CI: 11.6-17.2); pooled ORR was 49.4% (95% CI: 38.0-60.8%), DCR was 80.6% (95% CI: 70.9-87.7%), any-grade AE incidence was 74.2% (95% CI: 50.3-89.1%), and grade ≥3 AE incidence was 27.1% (95% CI: 17.1-40.2%). Conclusions: The comparative pairwise meta-analysis does not demonstrate an OS, PFS, or ORR benefit from adding SBRT to ICI-based treatment. Although the primary DCR estimate was statistically significant, its sensitivity to individual studies and the low certainty of evidence preclude a firm efficacy conclusion. Setting-specific randomized trials with standardized radiation, outcome, and toxicity definitions are needed.
Institutions: West China Hospital of Sichuan University, Lanzhou University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223404838