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Comparative Study
. 2025 Jul 24;25(1):1210.
doi: 10.1186/s12885-025-14593-z.

Comparison the efficiency of whole brain radiotherapy and simultaneous integrated boost in small cell lung cancer with brain metastases

Xia Shan #  1 , Wenqing Wang #  1 , Tao Zhang  1 , Wenyang Liu  1 , Jianyang Wang  1 , Xin Wang  1 , Yuqi Wu  1 , Zefen Xiao  1 , Jima Lv  1 , Qinfu Feng  1 , Nan Bi  2 , Zongmei Zhou  3 , Lei Deng  4
Affiliations
Comparative Study

Comparison the efficiency of whole brain radiotherapy and simultaneous integrated boost in small cell lung cancer with brain metastases

Xia Shan et al. BMC Cancer. .

Abstract

Background: This study aims to compare the therapeutic efficacy of whole brain radiotherapy (WBRT) versus WBRT plus simultaneous integrated boost (WBRT + SIB) in patients with brain metastases (BMs) from small cell lung cancer (SCLC).

Methods: A retrospective analysis was conducted on 127 patients with BMs from SCLC who received brain radiotherapy between 2014 and 2023 at the Cancer Hospital of the Chinese Academy of Medical Science. Among them, 71 patients underwent WBRT (25.0-54.0 Gy in 10-21 fractions), while 56 patients received WBRT + SIB (SIB to metastases: 18.0-60.0 Gy in 5-20 fractions). The overall survival (OS), intracranial progression-free survival (iPFS), objective response rate (ORR), and local control rate (LCR) were evaluated to assess the efficacy of the treatments.

Results: With a median follow-up of 14.9 months, the median OS was significantly longer in the WBRT + SIB group compared to the WBRT group (18.0 vs. 11.7 months). Similarly, the iPFS was extended in the WBRT + SIB group (12.2 vs. 7.6 months). Kaplan-Meier analysis revealed that WBRT + SIB significantly improved OS in patients with SCLC of BMs (P = 0.009). Subgroup analysis indicated that male patients, age < 60 years old, and multiple intracranial metastases benefited more from WBRT + SIB. Interaction tests suggested that age significantly influence the efficacy of WBRT + SIB, with patients < 60 years old deriving more benefit (P = 0.049). Concurrent WBRT + SIB with anti-angiogenic targeted therapy significantly improved iPFS (P < 0.001).

Conclusions: WBRT + SIB can prolong the OS in SCLC patients with BMs, with younger age and those receiving anti-angiogenesis therapy potentially achieving additional survival benefits.

Keywords: Brain metastases; Simultaneous integrated boost (SIB); Small cell lung cancer (SCLC); Therapeutic efficacy; Whole brain radiotherapy (WBRT).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All aspects of this study involving human subjects were performed in an ethical manner, in compliance with the Helsinki Declaration and approved by the Ethics Committee of Cancer Hospital Chinese Academy of Medical Sciences. Informed consent was waived by the Ethics Committee of Cancer Hospital Chinese Academy of Medical Sciences since our study was retrospective, and all the data were deidentified. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The K-M survival curves of OS (A) and iPFS (B) between the WBRT and WBRT + SIB groups. K-M, kaplan-Meier; OS, overall survival; iPFS, intracranial progression-free survival; WBRT, whole brain radiotherapy; SIB, simultaneous integrated boost
Fig. 2
Fig. 2
The K-M survival curves of OS in different subgroups. (A) OS in male patients, (B) OS in patients < 60 years old. (C) OS in patients with ≥ 2 BMs. K-M, kaplan-Meier; OS, overall survival; BMs, brain metastases
Fig. 3
Fig. 3
The forest plot of factors associated with OS in patients treated with WBRT versus WBRT + SIB. OS, overall survival; WBRT, whole brain radiotherapy; SIB, simultaneous integrated boost
Fig. 4
Fig. 4
The curative effect evaluation of the whole cohort. (A) ORR. (B) LCR. ORR, objective response rate; LCR, local control rate
Fig. 5
Fig. 5
The cut-off value calculation and the survival analysis within the WBRT + SIB group. (A, B) SIB dose. (C, D) the number of BMs. (E, F) Age. (G) The K-M survival curve of OS based on the targeted therapy status. (H) The K-M survival curve of iPFS based on the targeted status. WBRT, whole brain radiotherapy; SIB, simultaneous integrated boost; BMs, brain metastases; K-M, kaplan-Meier; OS, overall survival; iPFS, intracranial progression-free survival
Fig. 6
Fig. 6
The curative effect evaluation of the WBRT + SIB group. Grouped by the age (A, B) and the number of BMs (C, D). (A, C) ORR. (B, D) LCR. WBRT, whole brain radiotherapy; SIB, simultaneous integrated boost; BMs, brain metastases; ORR, objective response rate; LCR, local control rate
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