ArticleClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2026
Prophylactic cranial irradiation in the era of immunotherapy in extensive-stage small cell lung cancer: a systematic review and meta-analysis.
Article in Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeImmunotherapy has redefined the therapeutic landscape in extensive-stage small cell lung cancer (ES-SCLC). Whether the prophylactic cranial irradiation (PCI) remains relevant when paired with immunotherapy-based regimens remains unresolved. This study evaluated the efficacy of PCI in ES-SCLC patients treated with chemo-immunotherapy. MATERIALS AND
methodsA systematic review and pairwise meta-analysis were conducted per PRISMA guidelines, including studies from PubMed and Embase up to October 1, 2025. Outcomes were reported as hazard ratios (HR) for overall survival (OS), progression-free survival (PFS), brain metastasis-free survival (BMFS), and cumulative incidence of 1-year BM.
resultsFour retrospective cohort studies, with one only in form of abstract, involving 9992 participants were included. PCI combined with chemo-immunotherapy (n = 606) was associated with improved OS (HR = 0.78, 95%CI 0.68-0.9, p < 0.001), PFS (HR = 0.73, 95%CI 0.63-0.85, p < 0.001), and BMFS (HR = 0.36, 95%CI 0.24-0.54, p < 0.001). The 1-year cumulative incidence of BM was 15.85% (95%CI: 10.87-20.83%) with PCI, and 44.11% (95%CI: 42.2-46.03%) without. A survival benefit was not observed in studies that included patients with baseline brain magnetic resonance imaging (MRI) (HR = 0.74, 95%CI 0.5-1.11, p = 0.137).
conclusionsIn this study PCI was associated with reduced BM incidence and improved prognosis. However, the apparent survival benefit was driven by large registry-based studies that did not report baseline brain MRI and was not observed in the subgroup of patients with confirmed negative baseline brain MRI. Given the nonrandomized evidence base, these findings should be interpreted with caution, and prospective randomized studies are needed to clarify whether the observed PCI benefit is prophylactic or therapeutic.
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