Efficacy and prognostic factors of stereotactic radiosurgery versus whole-brain radiotherapy for brain metastases in small cell lung cancer: a systematic review and meta-analysis
A partir d'une revue systématique de la littérature publiée jusqu'en août 2025 (10 études, 41 240 patients), cette méta-analyse évalue l'efficacité d'une radiochirurgie stéréotaxique par rapport à une irradiation du cerveau entier pour des métastases cérébrales ayant pour origine un cancer du poumon à petites cellules puis identifie des facteurs pronostiques associés
Objective: To systematically evaluate the efficacy differences between stereotactic radiosurgery (SRS) and whole-brain radiotherapy (WBRT) in treating brain metastases from small cell lung cancer (SCLC), and to analyze key factors affecting patient prognosis, providing evidence-based support for developing individualized clinical treatment plans.
Methods: Strictly following PRISMA guidelines and registered on the PROSPERO platform (CRD420251147208), we systematically searched PubMed, Embase, Cochrane Library, and Web of Science databases for relevant literature from their inception to August 2025. Meta-analysis was performed using R software. The stability of results and publication bias were assessed through sensitivity analysis and funnel plots.
Results: 10 retrospective studies were included, involving 41,240 patients. Compared with WBRT, SRS significantly prolonged overall survival (HR = 0.74). Prognostic factor analysis showed that ECOG score 0–1 (HR = 0.61), female gender (HR = 0.89), receiving chemotherapy (HR = 0.37) or immunotherapy (HR = 0.69) were associated with better survival, while > 4 brain metastases (HR = 1.78), extracranial metastases (HR = 1.46), and age > 65 years (HR = 1.34) were poor prognostic factors. Sensitivity analysis indicated robust results, and funnel plot indicated no significant publishing bias.
Conclusion: In patients with SCLC brain metastases, SRS was associated with improved overall survival compared with WBRT, with particularly notable advantages in younger patients with good physical condition, limited intracranial lesions, and well-controlled systemic disease.
BMC Cancer , article en libre accès, 2026