JTO clinical and research reports · 2026
Prophylactic Cranial Irradiation and Survival in Limited-Stage SCLC: A Multicenter Real-World Analysis From the Canadian SCLC Database (CASCADE).
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Lone Abdul Hadee, Ye Xiang Y, Zhan Luna Jia, Yang Haechan, Smyth Victoria, Abdelaziz Riham H, Snow Stephanie, Genta Sofia, Kuruvilla Sara, Agulnik Jason, Navani Vishal, Ho Cheryl, Dawe David, Wheatley-Price Paul, Moore Sara, Liu Geoffrey, Lok Benjamin H
Аннотация
INTRODUCTION: Prophylactic cranial irradiation (PCI) is frequently used in limited-stage SCLC (LS-SCLC) to reduce the risk of brain failure after a response to chemoradiation. However, its benefit remains debated in the modern era, with improved imaging and surveillance techniques and evolving systemic therapy options. We conducted a nationwide real-world study using the CASCADE database to evaluate the impact of PCI on survival outcomes in patients with LS-SCLC.
METHODS: We analyzed patients from CASCADE, a Canadian multi-institutional database that includes patients with SCLC from nine institutions. Eligible patients with pathologically confirmed LS-SCLC diagnosed between 2004 and 2022 were included. We compared outcomes between patients receiving PCI and those omitting this treatment. Overall survival and progression-free survival were assessed using Kaplan-Meier methods and Cox proportional hazards models. Brain metastasis incidence was evaluated in a predefined subgroup of patients with data on brain failure outcomes using competing-risk methods, and a predefined subgroup analysis was conducted in patients with baseline brain magnetic resonance imaging.
RESULTS: We identified 607 patients eligible for analysis, with 388 receiving PCI and 219 without. Median overall survival was significantly increased in patients treated with PCI (29.8 versus 19.0 mo; p < 0.0001). With multivariable analysis, PCI remained independently associated with improved overall survival (hazard ratio = 0.70, 95% confidence interval: 0.57-0.86) and progression-free survival (hazard ratio = 0.61, 95% confidence interval: 0.50-0.74). Patients treated with PCI had a reduced incidence of brain metastasis. Notably, this improvement in survival was observed in patients who received baseline brain magnetic resonance imaging.
CONCLUSIONS: In this large, multi-institutional, real-world cohort, PCI for the treatment of LS-SCLC was associated with improved overall survival, likely driven in part by a reduced brain metastasis risk. These findings support the continued role of PCI and highlight the need for further study in the modern imaging era.
METHODS: We analyzed patients from CASCADE, a Canadian multi-institutional database that includes patients with SCLC from nine institutions. Eligible patients with pathologically confirmed LS-SCLC diagnosed between 2004 and 2022 were included. We compared outcomes between patients receiving PCI and those omitting this treatment. Overall survival and progression-free survival were assessed using Kaplan-Meier methods and Cox proportional hazards models. Brain metastasis incidence was evaluated in a predefined subgroup of patients with data on brain failure outcomes using competing-risk methods, and a predefined subgroup analysis was conducted in patients with baseline brain magnetic resonance imaging.
RESULTS: We identified 607 patients eligible for analysis, with 388 receiving PCI and 219 without. Median overall survival was significantly increased in patients treated with PCI (29.8 versus 19.0 mo; p < 0.0001). With multivariable analysis, PCI remained independently associated with improved overall survival (hazard ratio = 0.70, 95% confidence interval: 0.57-0.86) and progression-free survival (hazard ratio = 0.61, 95% confidence interval: 0.50-0.74). Patients treated with PCI had a reduced incidence of brain metastasis. Notably, this improvement in survival was observed in patients who received baseline brain magnetic resonance imaging.
CONCLUSIONS: In this large, multi-institutional, real-world cohort, PCI for the treatment of LS-SCLC was associated with improved overall survival, likely driven in part by a reduced brain metastasis risk. These findings support the continued role of PCI and highlight the need for further study in the modern imaging era.