Overview
Prophylactic cranial irradiation (PCI) is a preventive brain radiation treatment sometimes used for patients with extensive-stage small cell lung cancer (ES-SCLC) to lower the risk of cancer spreading to the brain, however, the overall survival benefits remain uncertain especially given concerns about long-term side effects. Modern immunotherapies also challenge the need for PCI, as they may also potentially reduce the risk of brain metastasis.
Researchers used data from the Flatiron Health Panoramic database comprised of >29K patients with SCLC to examine outcomes for over 2,500 US patients with ES-SCLC who responded to first-line platinum-based chemoimmunotherapy and had no brain metastases at diagnosis. The study found that PCI use has declined since the introduction of immunotherapy, and while PCI was linked to a lower risk of developing brain metastases and needing further brain radiation within one year, it did not significantly improve overall survival and only modestly extended the time before disease progression.
Why this matters
These findings suggest that, in the current treatment landscape, the benefits of PCI may be limited and should be weighed against potential risks. This research provides important real-world evidence to help doctors and patients make more informed decisions about using PCI in ES-SCLC care today.