The survival benefit of PCI in ES-SCLC reported by a European randomized trial (RCT) in 2007 was not replicated by a Japanese RCT published in 2017. This study aimed to evaluate the uptake of PCI before and after publication of the European RCT and its association with survival in ES-SCLC. We identified eligible patients in the only two Singapore national cancer centres from 2003 to 2010. We linked their electronic medical records to the national death registry. We described the utilization of PCI in patients diagnosed from 2003 to 2006 (pre-adoption cohort) with patients diagnosed from 2007 to 2010 (post-adoption cohort). We performed univariable and multivariable Cox regression analysis to assess the association between PCI and survival. We identified 224 patients with ES-SCLC with no brain metastases. Among the 71 patients who had at least stable disease after first line chemotherapy, there was an increase in the use of PCI from the period 2007 to 2010 compared with 2003 to 2006 (32% versus 10%, P = 0.044). PCI was associated with improved OS (hazard ratio 0.22, 95% CI 0.10 to 0.47, P < 0.001) compared to no PCI in the multivariable analysis. There was an increase in the adoption of PCI for ES-SCLC since 2007. PCI was associated with improved survival in patients who did not have mandatory MRI brain imaging prior to PCI and had stable disease or better after first line chemotherapy, suggesting that the results of the European RCT are reproducible in the real-world practice.

Background/Objectives: Synchronous ipsilateral supraclavicular lymph node metastases (sISLMs) in breast cancer are rare and associated with poor prognosis. The optimal locoregional treatment strategy remains unclear, particularly regarding the role of supraclavicular lymph node dissection (SLND). Methods: We conducted a systematic review and network meta-analysis, including studies published up to end December 2023, to compare the outcomes of SLND combined with radiotherapy (RT) and systemic therapy (ST), SLND with ST alone, and ST alone, using RT + ST as the reference. Results: Ten studies involving 3346 patients were included for overall survival (OS) analysis, and six studies were included for disease-free survival (DFS). SLND + RT + ST showed similar OS and DFS compared to RT + ST. Sensitivity analyses revealed that SLND limited to level V improved OS (HR: 0.47, 95% CI: 0.29–0.77), while more extensive dissections (level V+) worsened outcomes (HR: 1.41, 95% CI: 1.10–1.80). Conclusions: These findings suggest that selective SLND may benefit certain patients, but broader application should be approached with caution pending results from future randomized trials.

Background: Patients with advanced non-small-cell lung cancer (NSCLC) with activating mutations in the epidermal growth factor receptor ( EGFR ) gene are a heterogenous population who often develop brain metastases (BM). The optimal management of patients with asymptomatic brain metastases is unclear given the activity of newer generation targeted therapies in the central nervous system. We present a protocol for an individual patient data prospective meta-analysis (IPD-PMA) to evaluate whether the addition of stereotactic radiosurgery (SRS) before Osimertinib treatment will lead to better control of intracranial metastatic disease. This is a clinically relevant question that will inform practice. Methods: Randomised controlled trials (RCTs) will be eligible if they included: participants with BM arising from EGFR mutant NSCLC and suitable to receive Osimertinib both in the first- and second-line settings (P); comparisons of SRS followed by Osimertinib versus Osimertinib alone (I, C); and intracranial disease control included as an endpoint (O). Systematic searches of Medline (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), PsychInfo, ClinicalTrials.gov and the World Health Organisation’s International Clinical Trials Registry Platform’s Search Portal will be undertaken. An IPD meta-analysis will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome is intra-cranial progression free survival, as determined by RANO-BM criteria. Secondary outcomes include overall survival, time to whole brain radiotherapy, quality of life and adverse events of special interest. Effect differences will be explored among pre-specified subgroups. Ethics and dissemination: Approved by each trials ethics committee. Results will be relevant to clinicians, researchers, policymakers and patients, and will be disseminated via publications, presentations and media releases. Prospero registration: CRD42022330532 Strengths and Limitations of this study: The use of an individual patient data (IPD) meta-analysis will give increased statistical power for the relative comparison of SRS followed by Osimertinib versus Osimertinib alone on intracranial progression-free survival. Such a meta-analysis will also enable the exploration of subgroups. Frequency of outcome assessment and outcome measures may be collected and reported differently across included trials, which may lead to some imprecision. Harmonisation of clinical trial protocols through prospective meta-analysis will address some of these limitations. A limitation of this study is that the searches will only be conducted until late 2023 and any studies that are registered after this time will not be included.