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CASE REPORT article

Front. Oncol.

Sec. Radiation Oncology

Volume 15 - 2025 | doi: 10.3389/fonc.2025.1642564

This article is part of the Research TopicRecent Advances in Radiation Oncology for the Management of Thoracic MalignanciesView all 12 articles

A NON-SMALL CELL LUNG CANCER FRAGILE ELDERLY PATIENT TREATED WITH IMMUNOTHERAPY AND NON-ABLATIVE RADIATION THERAPY: A CASE REPORT OF A WINNING COMBINATION

Provisionally accepted
Jessica SaddiJessica Saddi1David Alberto Santos HernandezDavid Alberto Santos Hernandez2,3,4Giulia Maria StellaGiulia Maria Stella5,6Giulia GalliGiulia Galli6,7Sabrina BorgettoSabrina Borgetto7Elisabetta BonzanoElisabetta Bonzano1Andrea LanciaAndrea Lancia1Salvatore La MattinaSalvatore La Mattina1Sara ColomboSara Colombo1Luigi SquillaceLuigi Squillace1Guido BaiettoGuido Baietto8Chandra BortolottoChandra Bortolotto10,9Gioacchino D'AmbrosioGioacchino D'Ambrosio11Laura MantovaniLaura Mantovani12Paolo PedrazzoliPaolo Pedrazzoli6,7Francesco AgustoniFrancesco Agustoni6,7*
  • 1Department of Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  • 2Department of radiation oncology, Centro Nacional de Radioterapia, San Salvador, El Salvador
  • 3San Matteo Hospital Foundation (IRCCS), Pavia, Italy
  • 4Instituo Nacional de Salud, San Salvador, El Salvador
  • 5Unit of Respiratory Diseases, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Pavia, Italy
  • 6Department of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, Pavia, Italy
  • 7Department of Medical Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  • 8Unit of Thoracic Surgery, Cardiothoracic and Vascular Department, IRCCS Policlinico San Matteo, Pavia, Italy
  • 9Diagnostic Imaging and Radiotherapy Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
  • 10Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  • 11Pathology Unit, Department of Diagnostical Services and Imaging, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  • 12Department of Medical Physics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

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Background: radiation therapy is used in the clinical scenario of oligo-metastatic lung cancer as a weapon to delay the subsequent line of systemic therapy, particularly in the case of oligoprogressive disease. In this setting, the integration of immunotherapy and radiotherapy plays an important role to achieve local control and improve progression-free survival (PFS).Case presentation: we reported the case of an elderly fragile patient affected by advanced nonsmall cell lung cancer treated with pembrolizumab as first systemic line and immuno-modulant radiation therapy at oligo-progression. More specifically, he underwent stereotactic body radiation therapy using non-ablative regimen (24 Gy in 3 fractions) achieving partial response with abscopal effect and without drug interruption. After one year, during immunotherapy mediastinal and parenchymal progression occurred and he received another radiation treatment using conventional non-ablative regimen (40 Gy in 20 fractions). Complete response was observed without severe side effects (his poor respiratory function did not change during both treatments). Conclusion: in this case report we showed that the association of immunotherapy and nonablative radiation regimens may represent a safe and effective strategy to achieve complete response also in fragile patients, in whom the burden of side effects should be prioritized.

Keywords: NSCLC, Immunotherapy, Radiotherapy, non-ablative SBRT, SBRT

Received: 06 Jun 2025; Accepted: 16 Jul 2025.

Copyright: © 2025 Saddi, Santos Hernandez, Stella, Galli, Borgetto, Bonzano, Lancia, La Mattina, Colombo, Squillace, Baietto, Bortolotto, D'Ambrosio, Mantovani, Pedrazzoli and Agustoni. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Francesco Agustoni, Department of Medical Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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