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. 2012 Nov;23(11):2919-2924.
doi: 10.1093/annonc/mds123. Epub 2012 Jul 10.

Prophylactic cranial irradiation in small-cell lung cancer: findings from a North Central Cancer Treatment Group Pooled Analysis

S E Schild  1 , N R Foster  2 , J P Meyers  2 , H J Ross  3 , P J Stella  4 , Y I Garces  5 , K R Olivier  5 , J R Molina  6 , L R Past  7 , A A Adjei  5 ; North Central Cancer Treatment Group
Affiliations

Prophylactic cranial irradiation in small-cell lung cancer: findings from a North Central Cancer Treatment Group Pooled Analysis

S E Schild et al. Ann Oncol. 2012 Nov.

Abstract

Background: This pooled analysis evaluated the outcomes of prophylactic cranial irradiation (PCI) in 739 small-cell lung cancer (SCLC patients with stable disease (SD) or better following chemotherapy ± thoracic radiation therapy (TRT) to examine the potential advantage of PCI in a wider spectrum of patients than generally participate in PCI trials.

Patients and methods: Three hundred eighteen patients with extensive SCLC (ESCLC) and 421 patients with limited SCLC (LSCLC) participated in four phase II or III trials. Four hundred fifty-nine patients received PCI (30 Gy/15 or 25 Gy/10) and 280 did not. Survival and adverse events (AEs) were compared.

Results: PCI patients survived significantly longer than non-PCI patients {hazard ratio [HR] = 0.61 [95% confidence interval (CI): 0.52-0.72]; P < 0.0001}. The 1- and 3-year survival rates were 56% and 18% for PCI patients versus 32% and 5% for non-PCI patients. PCI was still significant after adjusting for age, performance status, gender, stage, complete response, and number of metastatic sites (HR = 0.82, P = 0.04). PCI patients had significantly more grade 3+ AEs (64%) compared with non-PCI patients (50%) (P = 0.0004). AEs associated with PCI included alopecia and lethargy. Dose fractionation could be compared only for LSCLC patients and 25 Gy/10 was associated with significantly better survival compared with 30 Gy/15 (HR = 0.67, P = 0.018).

Conclusions: PCI was associated with a significant survival benefit for both ESCLC and LSCLC patients who had SD or a better response to chemotherapy ± TRT. Dose fractionation appears important. PCI was associated with an increase in overall and specific grade 3+ AE rates.

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Figures

Figure 1.
Figure 1.
Survival impact of prophylactic cranial irradiation (PCI) (versus no PCI) across all extensive small-cell lung cancer patients.
Figure 2.
Figure 2.
Survival impact of prophylactic cranial irradiation (PCI) (versus no PCI) across all limited small-cell lung cancer patients.
Figure 3.
Figure 3.
Survival of limited small-cell lung cancer patients by prophylactic cranial irradiation dose fractionation (25 Gy/10 fractions versus 30 Gy/15 fractions).
See this image and copyright information in PMC

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