WCLC 2025 - Posters & ePosters-P3.13.10 Real-World Outcomes of Prophylactic Cranial Irradiation (PCI) in Extensive-Stage Small Cell Lung Cancer (ES-SCLC) in the US

P3.13.10 Real-World Outcomes of Prophylactic Cranial Irradiation (PCI) in Extensive-Stage Small Cell Lung Cancer (ES-SCLC) in the US

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This study investigated the real-world impact of prophylactic cranial irradiation (PCI) in patients with extensive-stage small cell lung cancer (ES-SCLC) treated in the chemoimmunotherapy era. Analysis of the Flatiron Health electronic health record database included 20,045 patients diagnosed after 2018, receiving first-line platinum-based chemotherapy with immunotherapy, and having no brain metastases at baseline.<br /><br />Findings showed that PCI use has declined in recent years. While PCI was associated with a reduced cumulative incidence of brain metastases (BM) and need for therapeutic brain radiation at one year, it did not improve real-world overall survival (rwOS). A modest benefit was observed in real-world progression-free survival (rwPFS), limited to approximately one additional month.<br /><br />Survival probability analyses at 6, 12, and 24 months demonstrated no significant rwOS advantage for patients undergoing PCI compared to those who did not receive it, though statistical significance trends appeared for BM incidence reduction. Given the limited survival benefit and potential risks or adverse effects of PCI, careful risk-benefit assessment is recommended when considering PCI in current clinical practice.<br /><br />In summary, while PCI may reduce brain metastasis occurrence and delay the need for brain radiotherapy in ES-SCLC patients receiving modern chemoimmunotherapy, it does not confer a significant survival advantage. Clinicians should weigh its use accordingly within the evolving treatment landscape influencing patient outcomes.

Asset Subtitle

Samantha Reiss

Meta Tag

Speaker Samantha Reiss

Topic Small Cell Lung Cancer and Neuroendocrine Tumors

Keywords

prophylactic cranial irradiation

PCI

extensive-stage small cell lung cancer

ES-SCLC

chemoimmunotherapy

brain metastases

overall survival

progression-free survival

Flatiron Health database

brain radiation