Prophylactic Cranial Irradiation May Improve Survival in Small Cell Lung Cancer

Radiation to the brain prior to detectable spread of cancer to the brain improved survival in patients with both early- and late-stage small cell lung cancer. These results were recently presented at the 2011 meeting of the American Society of Clinical Oncology.

Small-cell lung cancer (SCLC) is a fast-growing type of lung cancer and accounts for approximately 25%-30% of all lung cancers.  A common site spread, or metastasis, of SCLC is the brain. Once brain metastases have been detected, radiation directed to the sites of cancer is a common treatment.

Researchers have been evaluating the approach of whole-brain radiation prior to detection of brain metastases in patients with SCLC (prophylactic cranial irradiation) in an attempt to kill any undetectable cancer cells that may have spread to the brain.

Researchers from the North Central Cancer Treatment Group (NCCTG) recently performed an analysis to further evaluate the use of prophylactic cranial irradiation (PCI) among patients with SCLC. The analysis included 739 patients with SCLC; 318 patients had advanced SCLC and 421 patients had early SCLC.  Patients had received initial treatment with chemotherapy with or without radiation to the chest and achieved a stabilization or shrinkage of their cancer. Following initial therapy, one group of patients received PCI and the other group did not receive PCI.

  • Survival was significantly improved among patients with both advanced and early-stage SCLC who were treated with PCI.
  • At one year, survival was 73% for those treated with PCI and 52% for those not treated with PCI.
  • At 3 years, survival was 20% for those treated with PCI and 6% for those not treated with PCI.
  • Severe side effects occurred more frequently in patients treated with PCI (64%) compared with those not treated with PCI (50%).
  • The most common side effects associated with PCI were loss of hair, low levels of red blood cells, inflammation of the esophagus, and fatigue.

The authors stated that “PCI was associated with a significant survival benefit” which appeared in both early and late-stage SCLC among patients who derived benefit from initial chemotherapy.  However, due to the increase in side effects associated with PCI, it is important for patients to discuss their individual risks and benefits of this treatment approach with their healthcare provider.

Reference: Schild S, Foster N, Meyers J, et al. Prophylactic cranial irradiation (PCI) in small cell lung cancer (SCLC): Findings from the North Central Cancer Treatment Group (NCCTG) pooled analysis. Paper presented at the 2011 American Society of Clinical Oncology; June 3-7, 2011; Chicago, IL. Abstract 7074.

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