对于可切除的非小细胞肺癌（NSCLC），建议先进行新辅助化学免疫治疗，然后进行手术。然而，相当一部分患者不接受手术，而是选择放射治疗等替代治疗。放疗在这种情况下的疗效仍不清楚。这项回顾性研究分析了接受新辅助化学免疫治疗然后进行手术或放疗的 III 期 NSCLC 患者的数据。倾向评分匹配（PSM）用于平衡各组之间的异质性。评估了疗效结果、安全性和疾病复发模式。总共纳入 175 名患者； 50 人接受了放射治疗，125 人接受了手术。在匹配之前，放疗在无进展生存期方面逊于手术（PFS；风险比 [HR]，2.23；P = 0.008）。经过 1:1 PSM 调整后，每组由 40 名患者组成。放疗组的中位 PFS 为 30.8 个月，而手术组未达到（HR，1.46；P = 0.390）。放疗组的 12 个月和 24 个月 PFS 率分别为 90.4% 和 69.0%，而手术组分别为 94.1% 和 73.9%。 PSM 后的亚组分析表明，IIIA 期疾病患者比 IIIB 期疾病患者更能从手术中获益（HR，3.00；P = 0.074）。放疗组 62.5% 的患者和手术组 55.0% 的患者发生 3-4 级治疗相关不良事件 (TRAE)，没有报告 5 级 TRAE。放疗组和手术组中 3-4 级治疗相关性肺炎或肺炎的发生率分别为 7.5% 和 2.5%。 对于初始新辅助治疗后未接受手术切除的可切除 NSCLC 患者，放疗可能是手术的可行替代方案化学免疫疗法，提供可比的疗效和可控的安全性。需要更大规模的前瞻性研究来验证这些发现并优化该患者群体的治疗策略。版权所有 © 2024 作者。由 Elsevier B.V. 出版。保留所有权利。

Neoadjuvant chemoimmunotherapy followed by surgery is recommended for resectable non-small-cell lung cancer (NSCLC). However, a considerable proportion of patients do not undergo surgery and opt for alternative treatments such as radiotherapy. The efficacy of radiotherapy in this context remains unclear.This retrospective study analyzed data from patients with stage III NSCLC who received neoadjuvant chemoimmunotherapy followed by either surgery or radiotherapy. Propensity score matching (PSM) was used to balance the heterogeneity between the groups. Efficacy outcomes, safety profiles, and disease recurrence patterns were assessed.In total, 175 patients were included; 50 underwent radiotherapy, and 125 underwent surgery. Prior to matching, radiotherapy was inferior to surgery in terms of progression-free survival (PFS; Hazard ratio [HR], 2.23; P = 0.008). Following a 1:1 PSM adjustment, each group consisted of 40 patients. The median PFS was 30.8 months in the radiotherapy group and not reached in the surgery group (HR, 1.46; P = 0.390). The 12- and 24-month PFS rates were 90.4 % and 69.0 % for the radiotherapy group compared to 94.1 % and 73.9 % for the surgery group, respectively. Subgroup analyses after PSM showed that patients with stage IIIA disease tend to benefit more from surgery than those with stage IIIB disease (HR, 3.00; P = 0.074). Grade 3-4 treatment-related adverse events (TRAEs) occurred in 62.5 % of patients in the radiotherapy group and 55.0 % in the surgery group, with no grade 5 TRAEs reported. The incidence of grade 3-4 treatment-related pneumonitis or pneumonia was 7.5 % and 2.5 % in the radiotherapy and surgery groups, respectively.Radiotherapy may be a viable alternative to surgery in patients with resectable NSCLC who do not undergo surgical resection after initial neoadjuvant chemoimmunotherapy, offering comparable efficacy and a manageable safety profile. Larger prospective studies are needed to validate these findings and optimize the treatment strategies for this patient population.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.