Background: Prophylactic cranial irradiation (PCI) is recommended to decrease the incidence of brain metastases (BM) in extensive-stage small-cell lung cancer (ESSCLC) without BM after response to chemotherapy. However, PCI is associated with significant neurocognitive effects, and new studies are debating its benefits. Moreover, the introduction of immunotherapy in the management of the disease has raised new questions, and there is a lack of data on PCI and immunotherapy. We report a single-center retrospective study evaluating the impact of omitting PCI from real-life treatment, including immunotherapy, of patients with ES-SCLC. Methods: We identified patients followed at APHM between January 2014 and January 2021 for ES-SCLC without BM with an indication for PCI. The main assessment criteria considered in this study were overall survival (OS) and brain metastasis-free survival (BMFS) between patients who received PCI and those who did not. Results: 56 patients were included, 25 receiving PCI and 31 without PCI. The median follow-up was 16 months. Eighteen patients received immunotherapy, mostly in the group without PCI (p= 0.024). The median OS and BMFS were, respectively, 11.7 and 13.4 months in patients with PCI, and 20.3 and 10.7 months in patients without PCI, without any significant statistical difference (p= 0.412,p= 0.336). The prognostic factors highlighted in multivariate analysis were initial performance status (PS) < 2 for OS (HR = 2.74 (IC95% [1.23; 6.13])) and monocyte lymphocyte ratio (MLR) < 0.12 for BMFS (HR = 1.21 (IC95% [1.01; 1.45])). A recursive partitioning analysis (RPA) found PS, immunotherapy, and age to be influential factors for OS but not PCI. Conclusions: The clinical results of our study showed no benefit of PCI in terms of OS and BMFS for patients with ES-SCLC. This can be explained by the lack of benefit of PCI or by the introduction of immunotherapy.
背景：对于化疗后缓解的广泛期小细胞肺癌（ES-SCLC）无脑转移患者，推荐采用预防性全脑放疗（PCI）以降低脑转移发生率。然而，PCI会带来显著的神经认知影响，且新近研究对其获益存在争议。此外，免疫疗法在该疾病治疗中的应用引发了新的问题，目前尚缺乏PCI与免疫疗法联合使用的相关数据。本研究报道了一项单中心回顾性研究，旨在评估在包含免疫疗法的真实世界治疗中省略PCI对ES-SCLC患者的影响。 方法：我们纳入了2014年1月至2021年1月期间在APHM随访、无脑转移且具有PCI适应症的ES-SCLC患者。本研究主要评估指标为接受PCI与未接受PCI患者的总生存期（OS）和无脑转移生存期（BMFS）。 结果：共纳入56例患者，其中25例接受PCI，31例未接受PCI。中位随访时间为16个月。18例患者接受了免疫治疗，且该组患者多集中于未接受PCI组（p=0.024）。PCI组患者的中位OS和BMFS分别为11.7个月和13.4个月，非PCI组分别为20.3个月和10.7个月，两组间无显著统计学差异（p=0.412，p=0.336）。多变量分析显示，初始体能状态（PS）<2是OS的预后因素（HR=2.74（95%CI[1.23;6.13]）），单核细胞淋巴细胞比值（MLR）<0.12是BMFS的预后因素（HR=1.21（95%CI[1.01;1.45]））。递归分区分析（RPA）发现PS、免疫治疗和年龄是OS的影响因素，而PCI并非影响因素。 结论：本研究的临床结果显示，PCI未能为ES-SCLC患者带来OS或BMFS方面的获益。这一结果可能源于PCI本身缺乏益处，或与免疫治疗的引入有关。
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