Stereotactic versus hippocampal avoidance whole-brain radiotherapy combined with immune checkpoint inhibitors for multiple brain metastases in non-small cell lung cancer: a multi-center retrospective study

作者：Wang X, Zheng Y, Wang A, Zhao X, Ruan X, Wu C, Han C · 发表于：Frontiers in oncology · 年份：2026 · DOI：10.3389/fonc.2026.1757781 · 被引用次数：24 · 研究领域：brain metastases、hippocampal avoidance whole-brain radiotherapy、immune checkpoint inhibitors、non-small cell lung cancer、stereotactic radiotherapy

OBJECTIVE: The optimal radiotherapy (RT) approach combined with immune checkpoint inhibitors (ICIs) for non-small cell lung cancer (NSCLC) patients with multiple brain metastases (BM) remains controversial. This study compared the clinical efficacy of stereotactic radiotherapy (SRT) plus ICIs versus hippocampal avoidance whole-brain radiotherapy (HA-WBRT) plus ICIs in this population. METHODS: We retrospectively reviewed NSCLC patients with multiple BM(>4) who underwent RT plus ICIs from 2018 to 2024. Exclusion criteria included SRT-alone or WBRT-alone, Karnofsky performance status (KPS) <70, suspected leptomeningeal disease, or 1-4 BM lesions. Patients were divided into SRT+ICIs and HA-WBRT+ICIs cohorts by 1:1 propensity score matching (PSM). In the matched datasets, overall survival (OS) was the primary endpoint and intracranial progression-free survival (iPFS) was the secondary endpoint. Survival outcomes were analyzed using Kaplan-Meier and log-rank tests. Cox proportional hazards models identified factors associated with OS and iPFS. RESULTS: Of the 256 patients diagnosed, 124 eligible patients (992 lesions) were analyzed. After 1:1 PSM, each cohort included 62 patients (SRT+ICIs and HA-WBRT+ICIs). The SRT+ICIs cohort demonstrated significantly longer median OS(21.4 vs. 15.5 months; P<0.001) and median iPFS (10.5 vs. 8.1 months; P<0.001) compared to the HA-WBRT+ICIs cohort. On multivariate analysis, SRT+ICIs was independently associated with improved OS (HR 0.381,95% C...