Refining Patient Selection for Prophylactic Cranial Irradiation in Limited-Stage SCLC: A Multicenter Cohort Study

Area of Science:

• Oncology
• Radiation Oncology
• Clinical Trials

Background:

• Evaluating prophylactic cranial irradiation (PCI) efficacy in limited-stage small cell lung cancer (LS-SCLC).
• Identifying optimal patient selection strategies for PCI in LS-SCLC management.

Purpose of the Study:

• Assess PCI's impact on brain metastases (BM) and overall survival (OS) in LS-SCLC patients.
• Determine if PCI improves outcomes in contemporary LS-SCLC treatment.

Main Methods:

• Multi-institutional cohort study of LS-SCLC patients treated with chemoradiation (2006-2022).
• Comparison of BM incidence and OS between PCI and non-PCI groups.
• Subgroup analysis of PCI effects and assessment of salvage treatment outcomes.

Main Results:

• PCI significantly reduced BM incidence, primarily isolated BM, but not nonisolated BM.
• PCI improved OS across most subgroups, except in patients achieving complete response (CR).
• Patients with CR and isolated BM showed high remission rates and comparable OS with salvage treatment.

Conclusions:

• PCI did not enhance OS for LS-SCLC patients achieving CR.
• MRI surveillance and effective salvage treatment are potential alternatives for selected LS-SCLC patients.
• Stereotactic radiosurgery demonstrated superior outcomes for BM salvage treatment.