Prophylactic Cranial Irradiation Versus Active MRI Surveillance in Small Cell Lung Cancer: Systematic Review and...

Area of Science:

• Oncology
• Radiotherapy
• Neurology

Background:

• Prophylactic cranial irradiation (PCI) is a standard treatment for small cell lung cancer (SCLC).
• Emerging data suggests active MRI brain surveillance may offer comparable survival outcomes.
• This study systematically reviews and meta-analyzes outcomes comparing PCI and MRI surveillance in SCLC patients.

Purpose of the Study:

• To compare patient outcomes between prophylactic cranial irradiation (PCI) and active MRI brain surveillance in small cell lung cancer (SCLC).
• To evaluate the efficacy of PCI versus MRI surveillance in limited-stage and extensive-stage SCLC.
• To assess the impact on overall survival (OS), progression-free survival (PFS), and brain metastasis (BM) incidence.

Main Methods:

• Systematic review and meta-analysis of studies comparing PCI and active MRI brain surveillance.
• Searched Medline, Embase, Cochrane Library, Scopus, and Web of Science databases up to April 30, 2025.
• Pooled risk ratios (RR) and hazard ratios (HR) using a random-effects model for 2881 adult SCLC patients across 14 studies.

Main Results:

• In limited-stage SCLC, PCI significantly improved OS (HR 0.67), PFS (HR 0.77), and reduced BM incidence (RR 0.58).
• In extensive-stage SCLC, PCI significantly reduced BM risk (RR 0.49) but did not significantly improve OS (HR 0.89) or PFS (HR 0.90).

Conclusions:

• Prophylactic cranial irradiation (PCI) reduces brain metastasis in both limited and extensive-stage SCLC.
• Survival benefits of PCI are limited to patients with limited-stage SCLC.
• Active MRI brain surveillance may be preferred for extensive-stage SCLC due to comparable survival and reduced toxicity.