To compare the efficacy and safety of consolidative versus salvage stereotactic ablative radiotherapy (SABR) for primary lung tumors in stage IV non-small cell lung cancer (NSCLC).
Approach:
Patient Selection: Retrospective analysis of 90 patients with stage IV NSCLC who received SABR between October 2020 and November 2025, categorized into consolidative (n=64) and salvage (n=26) SABR.
Endpoints: Endpoints included local progression-free survival (LPFS), distant metastasis-free survival (DMFS), and overall survival (OS). Competing risk analyses and multivariable Cox regression were applied.
Key Findings:
Consolidative SABR showed a 1-year LPFS rate of 93.8% compared to 84.6% for salvage SABR (P = 0.848).
DMFS rates were 75.0% for consolidative SABR versus 61.5% for salvage SABR (P = 0.806).
OS rates were 96.2% for consolidative SABR and 77.6% for salvage SABR (P = 0.775).
In multivariable analysis, EGFR/ALK mutation was independently associated with improved LPFS, DMFS, and OS.
Grade ≥2 radiation pneumonitis occurred in 12.2% of patients with no significant difference between groups.
Interpretation:
The timing of SABR (consolidative vs. salvage) did not significantly affect long-term oncologic outcomes in stage IV NSCLC patients receiving effective systemic therapy.
Limitations:
Retrospective design may introduce selection bias.
Small sample size may limit generalizability of findings.
Conclusion:
Consolidative and salvage SABR achieved comparable outcomes.
