Mapping the evidence of stereotactic body radiotherapy combined with systemic therapy in oligometastatic and oligoprogressive non-small cell lung cancer: A visual synthesis of clinical outcomes and toxicity.

BACKGROUND

Stereotactic body radiotherapy (SBRT) is increasingly combined with targeted and immune therapies in oligometastatic (OMD) and oligoprogressive (OprogD) non-small cell lung cancer (NSCLC). The literature is expanding but heterogeneous, obscuring the strength of evidence across different clinical scenarios. This study aimed to provide clinicians with a structured synthesis of recent studies evaluating SBRT combined with systemic therapy in OMD and OprogD NSCLC.

METHODS

We performed an evidence-mapping synthesis of clinical studies published between 2021-2025 assessing SBRT with systemic therapy in OMD and OprogD NSCLC. Outcomes included progression-free survival (PFS), overall survival (OS), 1-year local control (LC), biologically effective dose (BED₁₀), and grade ≥3 radiotherapy-related toxicity. Studies were categorized by disease state and systemic therapy type. Results were visualized using heatmaps, lollipop plots, and bubble charts. Historical benchmarks were included for context.

RESULTS

Fifteen studies (5 randomized/prospective and 10 retrospective) were identified. SBRT combined with tyrosine kinase inhibitors (TKIs) in EGFR-mutant NSCLC yielded superior outcomes (PFS 15.0-29.9 months (mo), OS 25.5-59.6 mo), while immune checkpoint inhibitor (ICI) combinations showed favorable survival (PFS 18-27 mo, OS 30-72 mo). Dual-ICI regimens increased toxicity in central thoracic lesions. Best OS correlated with favorable tumor biology rather than treatment timing. BED₁₀ ≥100 Gy achieved LC >90%, with severe SBRT‑related toxicity uncommon (0-7.4%) except in dual‑ICI cohorts. In OprogD, SBRT extended systemic therapy benefit via PFS-OS dissociation and delayed treatment change.

CONCLUSION

SBRT combined with systemic therapy demonstrates encouraging survival and LC with acceptable toxicity. in OMD/OprogD NSCLC. Longest survival correlates more strongly with favorable tumor biology than treatment timing, supporting biomarker-driven patient selection. Future randomized trials should validate these patterns and establish precision-based treatment algorithms.