Prophylactic cranial irradiation in resected early stage small cell lung cancer: an updated systematic review and meta-analysis.

IF 3.3 2区医学 Q2 ONCOLOGY

Radiation Oncology Pub Date : 2025-05-20 DOI:10.1186/s13014-025-02644-5

Ze Yuan, Dan Tao, Dingyi Yang, Yong Jiang, Erha Munai, Siwei Zeng, Zhiying Zhou, Wei Zhou, Yongzhong Wu

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Abstract

Background: The use of prophylactic cranial irradiation (PCI) in early stage small cell lung cancer (SCLC) patients post-surgery remains controversial. This meta-analysis aimed to evaluate the efficacy of PCI in resected early stage SCLC patients.

Methods: Relevant literature was reviewed through PubMed, Cochrane, and Embase databases. The pooled hazard ratios (HRs) for overall survival (OS) were analyzed for the overall population, as well as for pathologically node-negative (pN0) and pathologically node-positive (pN+) patients. We also assessed the pooled HRs for brain metastasis-free survival (BMFS) in all patients. Sensitivity analyses were conducted to validate these results.

Results: A total of 13 retrospective studies were included, encompassing 3,530 postoperative SCLC patients, of whom 880 received PCI treatment. In the overall patient population, PCI significantly improved OS compared to non-PCI group (HR: 0.66, 95% CI 0.58-0.74, p < 0.001). For pN0 patients, there was no significant OS benefit from PCI (HR: 0.85, 95% CI 0.65-1.10, p = 0.22). In contrast, pN + patients showed a significant OS improvement with PCI (HR: 0.52, 95% CI 0.41-0.66, p < 0.001). Furthermore, PCI significantly improved BMFS in all patients (HR: 0.42, 95% CI 0.29-0.60, p < 0.001). Sensitivity analyses confirmed the stability of these results.

Conclusions: PCI was associated with a significant improvement in OS and BMFS in resected early stage SCLC patients. The benefits of PCI were particularly pronounced in pN + patients, whereas pN0 patients did not experience a significant OS benefit. These findings supported the selective use of PCI based on nodal status to optimize treatment outcomes in postoperative SCLC patients.

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早期小细胞肺癌切除术的预防性颅脑照射：一项最新的系统综述和荟萃分析。

背景：早期小细胞肺癌（SCLC）术后预防性颅脑照射（PCI）的应用仍存在争议。本荟萃分析旨在评估PCI在早期SCLC患者手术切除中的疗效。方法：通过PubMed、Cochrane和Embase数据库查阅相关文献。对总体人群以及病理淋巴结阴性（pN0）和病理淋巴结阳性（pN+）患者的总生存率（OS）进行汇总风险比（hr）分析。我们还评估了所有患者脑无转移生存（BMFS）的总hr。进行敏感性分析以验证这些结果。结果：共纳入13项回顾性研究，共纳入3530例SCLC术后患者，其中880例接受了PCI治疗。在整个患者群体中，与非PCI组相比，PCI显著改善了OS （HR: 0.66, 95% CI 0.58-0.74, p）。结论：PCI与切除的早期SCLC患者的OS和BMFS的显著改善相关。PCI的益处在pN +患者中尤为明显，而pN0患者没有明显的OS益处。这些发现支持基于淋巴结状态选择性使用PCI来优化术后SCLC患者的治疗结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiation Oncology ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

6.50

自引率

2.80%

发文量

181

审稿时长

3-6 weeks

期刊介绍： Radiation Oncology encompasses all aspects of research that impacts on the treatment of cancer using radiation. It publishes findings in molecular and cellular radiation biology, radiation physics, radiation technology, and clinical oncology.