Radiotherapy combined with drug-eluting bead bronchial artery chemoembolization for stage III non‐small‐cell lung cancer:a retrospective study

Background: Multiple large-scale phase III clinical trials have established concurrent chemoradiotherapy(cCRT)followed by immunotherapy（cCRT→IO）as the standard treatment for unresectable locally advanced non-small cell lung cancer (NSCLC). In clinical practice, many patients cannot tolerate cCRT and instead receive sequential therapy or radiotherapy alone, resulting in compromised outcomes. This study aimed to compare the safety and efficacy of radiotherapycombined with drug-eluting bead bronchial artery chemoembolization followed by immunotherapy (RT+DEB-BACE→IO) versus standard cCRT→IO in patients with unresectable stage III NSCLC. Methods: We conducted a retrospective analysis of patients with unresectable stage III NSCLC who received either RT+DEB-BACE→IO orcCRT→IO between June 2020 and December 2023. Propensity score matching (PSM) was employed to balance intergroup heterogeneity. Comparative assessments of safety and efficacy outcomes were performed between the two treatment groups. Results: Among 182 evaluable patients, RT+DEB-BACE（n=54）demonstrated superior initial objective response rates compared to cCRT (n=128)(70.4% vs 52.3%, p =0.025). The survival analysis cohort comprised 161 patients receiving consolidation immunotherapy (RT+DEB-BACE→IO: n=52; cCRT→IO: n=109). PSM created 48 balanced pairs per group. While unmatched analysis showed shorter median progression-free survival with RT+DEB-BACE→IO (12.5 vs 17.3 months, HR 1.58, p=0.038), this difference was non-significant post-matching (13.8 vs 14.7 months, HR 1.10, p=0.733). No significant overall survival difference was observed (2-year OS: 79.8% vs 72.4%, p=0.492). The subgroup analysis demonstrated equivalent clinical outcomes whether DEB-BACE was administered concurrently with or sequentially to radiotherapy prior to immunotherapy. Importantly, RT+DEB-BACE→IO showed significantly fewer grade 3/4 adverse events (9.6% vs 37.6%, p <0.01), particularly hematologic (7.7% vs 34.9%, p <0.01). Conclusions: For patients with unresectable stage III NSCLC, RT+DEB-BACE showed superior short-term efficacy compared to cCRT；When followed by IO consolidation, the RT+DEB-BACE→IO regimen exhibited significantly improved safety profiles versus cCRT→IO, while achieving comparable long-term survival outcomes. Prospective randomized trials are needed to further validate these findings.