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Induction Chemoimmunotherapy Followed by Consolidative Hypofractionated Radiotherapy for Unresectable Locally Advanced NSCLC: A Real-World Outcomes Analysis
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Caglayan Selenge Beduk Esen
1, 
Sukran Celikarslan
2,
Duygu Sezen
2,
Fatih Selcukbiricik
3,4,
Kerim Kaban
4,
Metin Kanitez
4,
Perran Fulden Yumuk
4,
Nil Molinas Mandel
4,
Levent Tabak
5,
Ezgi Cesur
6,
Suat Erus
7,
Serhan Tanju
7,
Sukru Dilege
6,7,
Terman Gumus
8,
Cetin Atasoy
9,
Cengiz Demirkurek
10,
Okan Falay
11,
Mehmet Onur Demirkol
10,11,
Pinar Bulutay
12,
Pinar Firat
12,
Melis Selek
13,
Merve Duman
2,
Sepideh Mohammadipour
1,
Saliha Ezgi Oymak
1,
Nulifer Kilic Durankus
2,
Yasemin Atagun
1,2 and
Ugur Selek
1,2,*add
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1
Department of Radiation Oncology, American Hospital, Istanbul 34365, Türkiye
2
Department of Radiation Oncology, Koç University School of Medicine, Istanbul 34450, Türkiye
3
Department of Medical Oncology, Koç University School of Medicine, Istanbul 34450, Türkiye
4
Department of Medical Oncology, American Hospital, Istanbul 34365, Türkiye
5
Department of Pulmonary Medicine, American Hospital, Istanbul 34365, Türkiye
6
Department of Thoracic Surgery, American Hospital, Istanbul 34365, Türkiye
7
Department of Thoracic Surgery, Koç University School of Medicine, Istanbul 34450, Türkiye
8
Department of Radiology, American Hospital, Istanbul 34365, Türkiye
9
Department of Radiology, Koç University School of Medicine, Istanbul 34450, Türkiye
10
Department of Nuclear Medicine, American Hospital, Istanbul 34365, Türkiye
11
Department of Nuclear Medicine, Koç University School of Medicine, Istanbul 34450, Türkiye
12
Department of Pathology, Koç University School of Medicine, Istanbul 34450, Türkiye
13
Koç University School of Medicine, Istanbul 34450, Türkiye
*
Author to whom correspondence should be addressed.
Cancers 2026, 18(13), 2036; https://doi.org/10.3390/cancers18132036 (registering DOI)
Submission received: 13 May 2026
/
Revised: 21 June 2026
/
Accepted: 22 June 2026
/
Published: 23 June 2026
(This article belongs to the Section Cancer Therapy)
Simple Summary
This real-world study evaluated hypofractionated thoracic radiotherapy after induction chemoimmunotherapy in patients with unresectable locally advanced non-small cell lung cancer. The treatment was associated with favorable locoregional control, encouraging survival outcomes, and acceptable toxicity. These findings support further prospective investigation of this sequential treatment strategy.
Abstract
Purpose/Objective: To evaluate the safety and failure patterns of consolidative hypofractionated thoracic radiotherapy (RT) following induction chemoimmunotherapy in patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC). Materials/Methods: This retrospective study included 34 patients treated between 2019 and 2025. All patients received induction chemoimmunotherapy followed by consolidative hypofractionated RT based on multidisciplinary tumor board recommendations. The primary endpoint was local recurrence (LR); secondary endpoints were regional recurrence (RR), distant metastasis (DM), overall survival (OS), progression-free survival (PFS), and treatment-related toxicity. Results: Median age was 64 years, and median PD-L1 expression was 20%. Most patients had stage III disease; squamous cell carcinoma (56%) and adenocarcinoma (38%) were the predominant histologies. The most common systemic regimen was carboplatin/paclitaxel plus nivolumab, with a median of four induction cycles. Post-induction response was complete in 21%, partial in 62%, stable in 12%, and progressive in 6%. Median RT dose was 52.5 Gy in 15 fractions, and maintenance immunotherapy was administered in 79%. At a median follow-up of 16.7 months, using cumulative incidence functions with death treated as a competing event, the 1- and 2-year cumulative incidences of local failure were 6.9% and 14.7%, respectively. The corresponding cumulative incidences of regional failure were 10.2% and 18.8%, while distant metastasis incidences were 15.9% and 39.2%. No isolated local or regional recurrences occurred. One- and two-year OS rates were 86% and 81%, and corresponding PFS rates were 76% and 54%. No grade 4–5 RT-related toxicity occurred; one grade 5 immune-related pneumonitis was observed. Conclusions: Consolidative hypofractionated RT following chemoimmunotherapy appears feasible and associated with favorable outcomes, supporting further prospective investigation.
