Local ablative therapy plus systemic treatment versus systemic therapy alone in oligometastatic non-small cell lung cancer: a systematic review and meta-analysis of randomized trials
In brief
Local treatment lowered death hazard by 32% in oligometastatic lung cancer
A meta-analysis of 16 randomized trials involving 1,343 patients found that adding local ablative treatment lowered the hazards of progression or death by 37% and death by 32%. Benefits varied by treatment and patient subgroup, while severe side effects and pneumonitis increased; which patients gain enough to justify added treatment remains key.
- Journal
- International journal of clinical oncology (Q1)
- Published
- 28 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yaocan Xu, Yingyun Liang, Weiwei Gao, Xiaomin Yang, Fengfei Qin, Zheng Tao, et al.
- PMID
- 42955614
- DOI
- 10.1007/s10147-026-03222-9
Why clinicians should know about it
- Picked for Radiation Oncology (paper of the day, 30 October 2026): LAT plus systemic therapy improves PFS and OS in oligometastatic
- Picked for Surgical Oncology (paper of the day, 30 October 2026): Local ablative therapy adds surgery for oligometastatic NSCLC
Abstract
BACKGROUND: This study aimed to evaluate the role of adding local ablative therapy (LAT) to standard systemic therapy (SST) in patients with oligometastatic non-small cell lung cancer (NSCLC). METHODS: We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) evaluating LAT in oligometastatic NSCLC. The primary outcomes were progression-free survival (PFS) and overall survival (OS). Pooled hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: Sixteen RCTs (1,343 patients) were included. LAT significantly improved PFS (HR 0.63, 95%CI 0.55-0.72) and OS (HR 0.68, 95%CI 0.58-0.81). In EGFR‑mutant patients, LAT improved PFS (HR 0.54, 95%CI 0.44-0.66) and OS (HR 0.52, 95%CI 0.40-0.67), with consistent benefits across mutation subtypes, TKI generations, and LAT timing. In chemotherapy and/or immunotherapy recipients, LAT improved PFS (HR 0.69, 95%CI 0.56-0.86) but not OS (HR 0.83, 95%CI 0.64-1.07). No benefit was seen with LAT added to immunotherapy alone (PFS: HR 0.86, 95% CI 0.66-1.13; OS: HR 0.87, 95%CI 0.55-1.36); however, in PD‑L1 ≥1% patients, LAT significantly improved PFS (HR 0.34, 95%CI 0.12-0.96). In the chemotherapy‑alone subgroup, LAT did not improve PFS (HR 0.49, 95%CI 0.23-1.06) or OS (HR 1.17, 95%CI 0.78-1.75), but significantly prolonged PFS in patients with ≤3 metastases (HR 0.34, 95%CI 0.21-0.57). By brain metastasis status, LAT improved PFS in patients without brain metastases (HR 0.54, 95%CI 0.37-0.78), with a trend toward OS benefit (HR 0.69, 95%CI 0.48-1.00), but not in those with asymptomatic/minimally symptomatic lesions (PFS: HR 0.67, 95%CI 0.43-1.07; OS: HR 0.89, 95%CI 0.60-1.32). LAT increased grade ≥3 AEs (RR 1.62, 95%CI 1.10-2.39) and pneumonitis (RR 6.28, 95%CI 2.02-19.35). CONCLUSIONS: Adding LAT to SST significantly improves survival in oligometastatic NSCLC, particularly in EGFR‑mutant patients receiving EGFR‑TKIs, in PD‑L1 ≥1% patients receiving immunotherapy, in those with ≤3 metastases receiving chemotherapy, and in patients without brain metastases. These findings support a biomarker‑ and burden‑stratified approach to integrating LAT.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.