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. 2025 Feb 14;25(1):266.
doi: 10.1186/s12885-025-13667-2.

Prophylactic cranial irradiation improved the prognosis in pT1-2N0M0 small cell lung cancers after complete resection: a retrospective real-world study

Xue Yang  1 , Yaolin Song  2 , Rongjian Xu  3 , Yaocheng Yang  4 , Lingxin Feng  1 , Qi Qi  1 , Hongmei Li  1 , Zhuang Yu #  5 , Jing Wang #  6 , Ning An #  7
Affiliations

Prophylactic cranial irradiation improved the prognosis in pT1-2N0M0 small cell lung cancers after complete resection: a retrospective real-world study

Xue Yang et al. BMC Cancer. .

Abstract

Background: The efficacy of prophylactic cranial irradiation (PCI) is still controversial in small cell lung cancer (SCLC) patients with pT1-2N0M0 disease after complete resection. The majority of previous studies haven't discerned the potential benefit of PCI in this subgroup of patients, probably due to the paucity of these patients and distinct treating modalities. The aim of this study is to demonstrate the potential medical benefit of PCI in these patients.

Methods: A retrospective study was conducted to evaluate the potential benefit of PCI in pT1-2N0M0 SCLC patients after complete resection. We retrospectively reviewed 112 pT1-2N0M0 SCLCs after complete resection and adjuvant chemotherapy between January 2013 and January 2022. Survival and Cox regression analysis were conducted to elucidate the potential medical benefit of PCI in these patients.

Results: The median overall survival (OS) has not been reached. The 2-year, 5-year, 8-year OS rate was 93.7%, 73.2%, and 65.7%, respectively. Brain metastasis (BM) was observed in 17.0% (19/112) patients during the process of follow-up. PCI significantly decreased the BM actuarial risk from 23.9 to 4.9% (log-rank p = 0.0097, HR = 0.180, 95% CI: 0.041-0.778). The brain metastasis free survival (BMFS, log-rank p = 0.02) and OS (log-rank p = 0.05) in PCI cohort were also significantly longer than that of non_PCI group. Cox analysis demonstrated that PCI was an independent prognostic factor in both BM actuarial risk (HR = 0.198, 95% CI: 0.046-0.859, p = 0.031) and BMFS (HR = 0.387, 95% CI: 0.169-0.890, p = 0.025). Moreover, T2 patients showed a significant superior prognosis in terms of BM actuarial risk with comparison to those with T1 disease in non_PCI cohort (log-rank p = 0.016, HR = 3.345, 95% CI: 1.177-9.511), whereas the difference could not be observed in PCI cohort.

Conclusions: PCI was significantly associated with a better clinical outcome in pT1-2N0M0 SCLC patients who received complete resection and adjuvant chemotherapy, especially in T2 patients.

Keywords: Adjuvant therapy; Brain metastasis; Prophylactic cranial irradiation; Small cell lung cancer; Survival advantage.

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Conflict of interest statement

Declarations. Ethic approval and consent to participate: The protocol of this study was established according to the ethical guidelines of the Helsinki Declaration and was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University. The identity number of project and ethics approval was QYFYWZLL28916. Written informed consent to participate was obtained from all of the participants in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of clinical outcomes between PCI and non_PCI patients in overall cohort. (A) Comparison of BM actuarial risk between PCI and non_PCI patients in overall cohort; (B) Comparison of BMFS curves between PCI and non_PCI patients; (C) Comparison of DMFS curves between PCI and non_PCI patients; (D) Comparison of LR actuarial risk between PCI and non_PCI patients; (E) Comparison of DFS curves between PCI and non_PCI patients; (F) Comparison of OS curves between PCI and non_PCI patients
Fig. 2
Fig. 2
Comparison of clinical outcomes between PCI and non_PCI patients in T1 patients. (A) Comparison of BM actuarial risk between PCI and non_PCI patients in T1 patients; (B) Comparison of BMFS curves between PCI and non_PCI patients; (C) Comparison of DMFS curves between PCI and non_PCI patients; (D) Comparison of LR actuarial risk between PCI and non_PCI patients; (E) Comparison of DFS curves between PCI and non_PCI patients; (F) Comparison of OS curves between PCI and non_PCI patients
Fig. 3
Fig. 3
Comparison of clinical outcomes between PCI and non_PCI patients in T2 patients. (A) Comparison of BM actuarial risk between PCI and non_PCI patients in T1 patients; (B) Comparison of BMFS curves between PCI and non_PCI patients; (C) Comparison of DMFS curves between PCI and non_PCI patients; (D) Comparison of LR actuarial risk between PCI and non_PCI patients; (E) Comparison of DFS curves between PCI and non_PCI patients; (F) Comparison of OS curves between PCI and non_PCI patients
Fig. 4
Fig. 4
Comparison of clinical outcomes between T1 and T2 patients in overall cohort, PCI cohort and non_PCI cohort, respectively. (A) Comparison of BM actuarial risk between T1 and T2 patients in overall cohort; (B) Comparison of BMFS curves between T1 and T2 patients in overall cohort; (C) Comparison of OS curves between T1 and T2 patients in overall cohort; (D) Comparison of BM actuarial risk between T1 and T2 patients in PCI cohort; (E) Comparison of BMFS curves between T1 and T2 patients in PCI cohort; (F) Comparison of OS curves between T1 and T2 patients in PCI cohort; (G) Comparison of BM actuarial risk between T1 and T2 patients in non_PCI cohort; (H) Comparison of BMFS curves between T1 and T2 patients in non_PCI cohort; (I) Comparison of OS curves between T1 and T2 patients in non_PCI cohort
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