Effectiveness of local ablative therapy combined with first-line tyrosine kinase inhibitors in epidermal growth factor receptor-mutated oligometastatic non-small cell lung cancer: a systematic review and meta-analysis

Epidermal Growth Factor Receptor (EGFR) mutations are a significant driver of NSCLC. Although EGFR-Tyrosine Kinase Inhibitors (TKIs) improve outcomes, the development of resistance limits the survival advantages. Local Ablative Therapy (LAT), particularly radiotherapy, may further enhance outcomes in oligometastatic NSCLC, but its benefit remains uncertain. This meta-analysis evaluates the efficacy of LAT with TKI vs. TKI alone. We systematically searched PubMed, Embase, Web of Science, and Cochrane from inception to May 2025 for studies comparing TKI + LAT versus TKI alone, in patients with EGFR-mutated oligometastatic NSCLC. PRISMA guidelines were followed. Outcomes included overall survival (OS), progression-free survival (PFS), and treatment related adverse effects. We pooled hazard ratios (HR) and risk ratios (RR) with a 95% confidence interval (CI) using a random effects model. Statistical Analysis was performed using R software (version 4.4.2). We included 9 studies with 1077 patients, of whom 525 (48.7%) belonged to the TKI + LAT group. Mean follow-up duration was 29.3 months. Patients receiving TKI + LAT had a significantly longer OS (HR 0.50; 95% CI 0.42-0.59; p < 0.001) and PFS (HR 0.44; 95% CI 0.34-0.58; p < 0.001) versus TKI alone. The toxicity risk was not statistically different between the arms, suggesting that LAT did not significantly increase adverse effects. LAT combined with TKI is associated with improved survival in selected patients with EGFR-mutated oligometastatic NSCLC, particularly when delivered as consolidation therapy, with an acceptable safety profile.