{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T22:09:33Z","timestamp":1793657373593,"version":"4.5.1"},"reference-count":17,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"\n Importance<\/jats:title>\n Chemoimmunotherapy followed by immunotherapy maintenance is the standard first-line treatment for extensive-stage small cell lung cancer (ES-SCLC), yet data regarding efficacy and safety of consolidative thoracic radiotherapy (TRT) are lacking.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether combining consolidative TRT with immunotherapy maintenance in ES-SCLC is safe and improves patients\u2019 overall survival (OS) and progression-free survival (PFS).<\/jats:p>\n <\/jats:sec>\n \n Design, Settings, and Participants<\/jats:title>\n This was a multicenter open-label phase 2 randomized clinical trial recruiting patients from September 2020 to August 2022 in Germany and Austria, with the last follow-up visit in September 2024. Eligible patients had ES-SCLC with at least stable disease after induction chemoimmunotherapy (carboplatin\u2212etoposide\u2212atezolizumab). Although the database was locked in April 2025, a post hoc survival update was performed in April 2026. Data were analyzed from April 2025 to April 2026.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Randomized (1:1) to either atezolizumab maintenance combined with consolidative TRT (30 Gy in 10 fractions) (arm A) or atezolizumab maintenance alone (arm B).<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measure<\/jats:title>\n OS (time from randomization to death due to any cause).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 96 patients assessed for eligibility, 68 patients were randomized; recruitment was prematurely terminated due to safety concerns. Median OS in the combination arm was numerically shorter compared to atezolizumab only (6.7 months [95% CI, 5.1-9.0] vs 13.4 months [95% CI, 10.7-17.5]; HR, 1.55 [95% CI, 0.90-2.69];\n P<\/jats:italic>\n \u2009=\u2009.34), while median PFS was similar (2.4 months [95% CI, 1.3-3.9] vs 2.6 months [95% CI, 1.2-3.9]; HR, 0.92 [95% CI, 0.54-1.55];\n P<\/jats:italic>\n \u2009=\u2009.85). TRT plus atezolizumab was accompanied by higher frequency of severe adverse events (SAEs) (19 patients [61.3%] vs 6 patients [18.2%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and fatal outcomes (6 patients [19.4%] vs 1 patient [3.0%];\n P<\/jats:italic>\n \u2009=\u2009.04). Safety analysis revealed predominance of infection and respiratory disorder\u2212related SAEs, possibly facilitated by a depletion of lymphocytes observed specifically in patients after TRT, and by a lower single breath diffuse capacity of the lungs for carbon monoxide in patients with fatal AEs in arm A. No further risk factors were identified, given that baseline characteristics were well balanced between both arms and between patients with and without SAEs, including fatal SAEs.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial, TRT combined with immunotherapy increased toxic effects in unselected patients with ES-SCLC without survival benefit, presumably due to radiation-induced lymphocyte depletion facilitating infections. Cautious patient selection and further investigation to identify those who may benefit without undue risk are required.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04462276<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoncol.2026.2330","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T15:00:23Z","timestamp":1783609223000},"page":"965","source":"Crossref","is-referenced-by-count":6,"title":["Consolidative Thoracic Radiotherapy With Atezolizumab Maintenance in Extensive-Stage Small Cell Lung Cancer"],"prefix":"10.1001","volume":"12","author":[{"given":"Farastuk","family":"Bozorgmehr","sequence":"first","affiliation":[{"name":"Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Heidelberg, Germany"},{"name":"Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inn","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between German Cancer Research Center (DKFZ) and Heidelberg University Hospital, Heidelberg, Germany"},{"name":"Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rouven","family":"Behnisch","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometry, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Weykamp","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg University"},{"name":"Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany"},{"name":"National Center for Tumor Diseases (NCT), Heidelberg, Germany"},{"name":"Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Adeberg","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospital Marburg, Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Overbeck","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, University Medical Center Goettingen, Comprehensive Cancer Center Lower Saxony, Goettingen Site, Goettingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"El Shafie","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology, University Medical Center Goettingen, Comprehensive Cancer Center Lower Saxony, Goettingen Site, Goettingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Maguire","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hematology, Barmherzige Br\u00fcder Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan A.","family":"Koerber","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Barmherzige Br\u00fcder Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva Lotte","family":"Buchmeier","sequence":"additional","affiliation":[{"name":"Department of Thoracic Oncology, City of Cologne Municipal Hospitals, Lung Hospital Cologne Merheim, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela","family":"Hammer-Hellmig","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, City of Cologne Municipal Hospitals, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Gauler","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"P\u00f6ttgen","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Wermke","sequence":"additional","affiliation":[{"name":"Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany, and National Center for Tumor Diseases, Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther G. C.","family":"Troost","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany, and National Center for Tumor Diseases, Dresden, Germany"},{"name":"OncoRay\u2212National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus TUD Dresden University of Technology, Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konrad","family":"Kokowski","sequence":"additional","affiliation":[{"name":"Department of Pneumonology, Bogenhausen Hospital, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"R\u00f6per","sequence":"additional","affiliation":[{"name":"Ambulatory Health Care Centre \u201cDie Radiologie,\u201d Munich, 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Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"23","key":"coi260034r1","doi-asserted-by":"publisher","first-page":"2220","DOI":"10.1056\/NEJMoa1809064","article-title":"First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer.","volume":"379","author":"Horn","year":"2018","journal-title":"N Engl J Med"},{"issue":"2","key":"coi260034r2","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1097\/CCO.0000000000000352","article-title":"Radiotherapy in combination with immune checkpoint inhibitors.","volume":"29","author":"De Ruysscher","year":"2017","journal-title":"Curr Opin Oncol"},{"issue":"2","key":"coi260034r3","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.jtho.2019.10.024","article-title":"Phase II trial of concurrent atezolizumab with chemoradiation for unresectable NSCLC.","volume":"15","author":"Lin","year":"2020","journal-title":"J Thorac 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