非小细胞肺癌（NSCLC）的胸部放疗（RT）可能克服酪氨酸激酶抑制剂（TKI）的抗药性。然而，严重的治疗相关性肺炎（TRP）的风险是一个主要关注点，并且联合治疗的结果仍存在争议。因此，我们旨在系统地回顾已有的文献，并对胸部RT与TKI联合治疗中的TRP进行荟萃分析。我们使用PubMed-MEDLINE和Embase数据库进行系统文献回顾，以确定符合条件的文献。从中提取严重TRP的3级或更高级别的病例数，然后通过固定效应模型或随机效应模型进行分析。使用I²和τ²统计方法进行异质性检验。然后对放疗类型和联合治疗顺序进行亚组分析。我们的文献搜索确定了37个合格研究，涉及1143名患者。总体上，严重的TRP发生率为3.8%（95%置信区间[CI]为1.8%至6.5%），而致命性肺炎罕见，仅为0.1%（95% CI，0.0%至0.3%）。在亚组分析中，对于接受根治性（化疗）放疗的患者，严重TRP比例为2.3%（95% CI，1.0%至4.1%）（19个研究，n=702），而对于接受局部立体定向体放疗或姑息性放疗的患者，严重TRP比例为2.9%（95% CI，1.3%至5.1%）（15个研究，n=361）。合并TKI和RT的严重TRP发生率为4.9%（95% CI，2.4%至8.1%）（26个研究，n=765），明显高于顺序治疗TRP的0.4%（95% CI，0.0%至3.1%）（6个研究，n=200）。我们的荟萃分析显示，NSCLC患者接受联合胸部RT和EGFR-TKI治疗的严重TRP风险可接受，死亡率罕见。但并发治疗的耐受性较低，应谨慎使用。由于关于Osimertinib的影响数据有限，需要进一步研究。版权所有 © 2023. Elsevier Inc. 发布。

Thoracic radiotherapy (RT) for non-small cell lung cancers (NSCLCs) may overcome resistance to tyrosine kinase inhibitors (TKIs). However, the risk of severe treatment-related pneumonitis (TRP) is a major concern, and the results of the combined treatment remain controversial. Therefore, we aimed to systematically review existing publications and provide a meta-analysis of TRP from a combined therapy of thoracic RT and TKIs.A systematic literature review was performed using the PubMed-MEDLINE and Embase databases to identify eligible publications. The number of severe TRP cases of grade 3 or higher was extracted and then analyzed by fixed or randomized model meta-analysis. Heterogeneity tests were performed using the I² and τ² statistics. Subgroup analyses were conducted on the types of RT and the sequence of the combined treatment.Our literature search identified 37 eligible studies with 1143 patients. The severe TRP occurred in 3.8% (95 % confidential interval [CI], 1.8 to 6.5%) of patients overall, and fatal pneumonitis occurred rarely in 0.1% (95% CI, 0.0% to 0.3%). In the subgroup analysis, the severe TRP proportion was 2.3% (95% CI, 1.0% to 4.1%) for patients under definitive (chemo)RT (19 studies, n=702) versus 2.9% (95% CI, 1.3% to 5.1%) for patients who received local stereotactic body radiotherapy or palliative RT (15 studies, n=361). The severe TRP rate was 4.9% (95% CI, 2.4% to 8.1%) for concurrent TKI and RT (26 studies, n=765), which was significantly higher than TRP of 0.4% (95% CI, 0.0% to 3.1%) for sequential therapy (6 studies, n=200).Our meta-analysis showed that combined thoracic RT and EGFR-TKI therapy has an acceptable risk of severe TRP and rare mortality in patients with NSCLC. Concurrent treatment is less tolerable and should be administered with caution. Further investigations using Osimertinib are required as the data on its effects are limited.Copyright © 2023. Published by Elsevier Inc.