Centrally Confined 8Gy/1f to Tumor Core Followed by Concurrent Chemoradiotherapy for Unresectable Stage III NSCLC

Inclusion criteria

• Age 18 to 75 years;
• Histologically or cytologically confirmed NSCLC;
• Unresectable stage III disease according to the AJCC 8th edition;
• Negative for driver gene alterations;
• Considered suitable for definitive cCRT by MDT discussion or investigator judgment;
• ECOG performance status 0-1;
• Presence of a clearly delineable pulmonary primary lesion allowing centrally confined priming treatment planning;
• Adequate major organ function as required by the study;
• Willingness to participate and provision of written informed consent.

Exclusion criteria

• Presence of distant metastasis;
• Positive driver gene alterations;
• Prior definitive thoracic radiotherapy or prior systemic antitumor treatment for the current disease;
• Active autoimmune disease or need for long-term systemic immunosuppressive therapy;
• Active interstitial lung disease, prior severe radiation pneumonitis, or immune-related pneumonitis;
• Special primary tumor location such that safety constraints for centrally confined priming radiotherapy cannot be met;
• Primary lesion immediately adjacent to the main bronchus, carina, major vessels, or esophagus, such that the investigator judges the lead-in intervention to be excessively risky;
• Pregnancy or lactation;
• Any other condition that, in the opinion of the investigator, makes the patient unsuitable for this study.