Abstract
OBJECTIVE: This study was designed to evaluate the efficacy and safety of brain radiotherapy combined with immune checkpoint inhibitors (ICIs) retrospectively in small-cell lung cancer (SCLC) patients with brain metastases (BMs). METHODS: A retrospective analysis was conducted on 42 SCLC patients with BMs, who received brain radiotherapy combined with ICIs at our Hospital from 2020 to 2024. They received chemotherapy plus ICIs regimens and brain radiotherapy, and received concurrent/sequential thoracic radiotherapy. This study investigated the forms of WBRT vs. WBRT+ simultaneous integrated boost (SIB, different doses of radiation being delivered simultaneously to different parts of the tumor) combined with ICIs on overall survival (OS), intracranial local control (iLC), and radiotherapy adverse reactions (side effection). The Kaplan-Meier method was used for survival rate analysis. The log-rank test was used to compare the survival curves between different groups, and the chi-square (χ(2)) test was used to compare categorical data. RESULTS: In all the patients, the median follow-up time was 19.2 (range: 9.79-36.8) months. The 2-year OS rate and iLC rate were 42.3% and 68.8%, respectively. A total of 26 patients died of disease progression; 2 patients developed radiation-induced brain necrosis. The results showed that there was no significant difference in radiation-induced brain necrosis between the two groups. The WBRT patients suffered high rates of headache, dizziness, nausea, and radiodermatitis. The 2-year OS and iLC were brilliant. CONCLUSIONS: When brain radiotherapy combined with ICIs, even WBRT or WBRT + SIB had well OS and iLC with tolerable side reactions. Its indications needed to be considered from multiple perspectives. Further evaluation of brain radiotherapy combined with ICIs in SCLC BMs is required. Further prospective studies should be conducted to verify the conclusions.