2533 - Prophylactic Cranial Irradiation in Resected Early Stage Small Cell Lung Cancer: An Updated Systematic Review and Meta-Analysis
Presenter(s)
Z. Yuan, D. Tao, and W. Zhou; Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China, China
Purpose/Objective(s): The use of prophylactic cranial irradiation (PCI) in early-stage small cell lung cancer (SCLC) patients post-surgery remains controversial. This meta-analysis aims to evaluate the efficacy of PCI in early-stage SCLC patients following surgery.
Materials/Methods: A systematic review was conducted by searching PubMed, Cochrane, and Embase databases for studies published between 1990 and 2024. Hazard ratios (HRs) for overall survival (OS) and brain metastasis survival (BMFS) were pooled using a random-effects model. Subgroup analyses were performed based on nodal status (pathologically node-negative (pN0) vs. pathologically node-positive (pN+)). Heterogeneity was assessed using the I2 statistic, and sensitivity analyses were conducted to ensure result stability. Statistical analyses were performed using STATA 18.0 software.
Results: A total of 13 retrospective studies were included, encompassing 3,530 postoperative SCLC patients, of whom 880 (24.9%) received PCI treatment. In the overall patient population, PCI significantly improved OS compared to the non-PCI group (HR: 0.66, 95% CI 0.58-0.74, P < 0.001, I2 = 0%). For pN0 patients, there was no significant OS benefit from PCI (HR: 0.85, 95% CI 0.65-1.10, P = 0.22, I2 = 30.98%). In contrast, pN+ patients showed a significant OS improvement with PCI (HR: 0.52, 95% CI 0.41-0.66, P < 0.001, I2 = 7.14%). Furthermore, PCI significantly improved BMFS in all patients (HR: 0.42, 95% CI 0.29-0.60, P < 0.001, I2 = 0%). Sensitivity analyses confirmed the stability of these results.
Conclusion: PCI is associated with a significant improvement in OS and BMFS in postoperative SCLC patients. The benefits of PCI are particularly pronounced in pN+ patients, whereas pN0 patients do not experience a significant OS benefit. These findings support the selective use of PCI based on nodal status to optimize treatment outcomes in postoperative SCLC patients.