| Immune checkpoint inhibitors (ICI) combined with chemotherapy are now the first-line standard for extensive-stage small cell lung cancer (ES-SCLC), significantly improving survival, yet intrathoracic recurrence remains a major challenge. Pre-immunotherapy studies established the benefits of consolidative thoracic radiotherapy (cTRT) for local control and survival in chemo-sensitive ES-SCLC. However, in the immunotherapy era, the definitive efficacy, safety, optimal dose fractionation, timing of intervention, and target volume delineation principles for cTRT still require prospective validation. Concurrently, the activity of immunotherapy against brain metastases (BM) necessitates a re-evaluation of the clinical value of prophylactic cranial irradiation (PCI). This article systematically examines the clinical value, dose fractionation optimization, optimal timing, and target delineation principles of cTRT for ES-SCLC patients in the immunotherapy era, and analyzes the feasibility and role of PCI within this novel therapeutic paradigm, aiming to provide a theoretical basis for optimizing multidisciplinary treatment strategies. |
