SMARCA4-deficient pulmonary neoplasms have emerged as a major focus of lung cancer research in recent years. This subtype is characterized by aggressive behavior and poor prognosis. However, radiotherapy-related studies in this population remain scarce, and evidence is lacking regarding the optimal selection of radiotherapy parameters and the sequencing of combination with immunotherapy. The present study aimed to evaluate the efficacy of radiotherapy in these tumors and to explore the prognostic value of radiotherapy parameters. Clinical data of 88 patients with SMARCA4-deficient pulmonary neoplasms were retrospectively analyzed. Patients were divided into a radiotherapy group (n=20) and a non-radiotherapy group (n=68). Overall survival (OS) was compared between groups using the Kaplan-Meier method. Subgroup analyses were performed for radiotherapy site, biological equivalent dose (BED), fractionation mode, and the timing of radiotherapy combined with immunotherapy. The radiotherapy group had a lower proportion of patients aged ≥60 years (25.0% vs 66.2%, P<0.001) and a higher proportion receiving immunotherapy (65.0% vs 33.8%, P=0.013) compared with the non-radiotherapy group. The median OS was not reached in the radiotherapy group, which was significantly superior to that in the non-radiotherapy group (22.9 mon, P=0.048). Among patients receiving radiotherapy, those who also received immunotherapy had a significantly longer median OS than those receiving radiotherapy alone. No statistically significant differences in OS were observed among subgroups stratified by radiotherapy site, BED, fractionation schedule or timing. Radiotherapy effectively improves OS in SMARCA4-deficient lung tumors, with synergistic potential when combined with immunotherapy. The lack of prognostic impact of radiotherapy parameters supports regimen simplification, while the timing of combined therapy needs refinement. These exploratory results lay a critical foundation for future large‑sample confirmatory studies. 【中文题目：SMARCA4缺失型肺部肿瘤放疗疗效
及相关参数分析】 【中文摘要：背景与目的 SMARCA4缺失型肺部肿瘤是近年来肺癌研究的热点领域之一，该亚型侵袭性强、预后差，但其放疗相关研究仍十分匮乏，放疗参数的选择及联合免疫治疗的时序缺乏循证依据。本研究评估放疗在该类肿瘤中的疗效，并探讨放疗参数的预后价值。 方法 回顾性分析88例SMARCA4缺失型肺部肿瘤患者，分为放疗组（n=20）和未放疗组（n=68）。采用Kaplan-Meier法比较组间总生存（overall survival, OS），并分析放疗部位、生物等效剂量（biological effective dose, BED）、分割模式及免疫治疗时序对预后的影响。结果 放疗组年龄≥60岁比例更低（25.0% vs 66.2%, P<0.001），接受免疫治疗比例更高（65.0% vs 33.8%, P=0.013）。放疗组中位OS未达到，显著优于未放疗组（22.9个月，P=0.048）；放疗人群中，放疗联合免疫治疗组中位OS显著优于单纯放疗组。放疗部位、BED、分割方式和治疗时序组间的OS差异均无统计学意义。结论 放疗是改善SMARCA4缺失型肺部肿瘤患者OS的有效手段，联合免疫治疗可协同增效；放疗参数对预后无显著影响，有利于临床方案简化；放疗与免疫治疗时序需要优化，当前探索性结论为后续大样本研究提供了重要的假设基础。
】 【中文关键词：肺肿瘤；SMARCA4缺失；未分化肿瘤；放射治疗；免疫治疗】.
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arXiv · 2025-02-24
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