Stereotactic versus whole-brain radiotherapy combined with immunotherapy in driver gene–negative NSCLC with brain metastases: a real-world IPTW analysis

BackgroundBrain metastases (BMs) are a common and prognostically unfavorable complication of non-small cell lung cancer (NSCLC). Although the combination of immune checkpoint inhibitors (ICIs) with radiotherapy has shown potential in the treatment of BMs, there is a lack of comparative studies specifically contrasting whole-brain radiotherapy (WBRT) versus stereotactic radiotherapy (SRT), each combined with immunotherapy.

This study aimed to systematically evaluate the efficacy and safety of WBRT plus immunotherapy (WBRT+I) versus SRT plus immunotherapy (SRT+I) in patients with driver-gene-negative NSCLC accompanied by BMs.MethodsThis single-center, real-world retrospective cohort study enrolled patients with driver gene-negative NSCLC and BMs who received their first course of intracranial radiotherapy at Chongqing University Cancer Hospital between January 2018 and June 2024. Inverse Probability of Treatment Weighting (IPTW) was applied to balance baseline variables between the WBRT+I and SRT+I groups.

Survival outcomes were evaluated using Kaplan-Meier analysis and Cox regression. The primary endpoints were overall survival (OS) and intracranial progression-free survival (iPFS).