AUTHOR=Saddi Jessica , Santos Hernandez David Alberto , Stella Giulia Maria , Galli Giulia , Borgetto Sabrina , Bonzano Elisabetta , Lancia Andrea , La Mattina Salvatore , Colombo Sara , Squillace Luigi , Baietto Guido , Bortolotto Chandra , D’Ambrosio Gioacchino , Mantovani Laura , Pedrazzoli Paolo , Agustoni Francesco 

TITLE=A non-small cell lung cancer fragile elderly patient treated with immunotherapy and non-ablative radiation therapy: a case report of a winning combination

JOURNAL=Frontiers in Oncology

VOLUME=Volume 15 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2025.1642564

DOI=10.3389/fonc.2025.1642564

ISSN=2234-943X

ABSTRACT=BackgroundRadiation 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 oligo-progressive 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 presentationWe reported the case of an elderly fragile patient affected by advanced non-small 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).ConclusionIn this case report we showed that the association of immunotherapy and non-ablative 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.