title: Single fraction prophylactic cranial irradiation for small cell carcinoma of the lung.
abstract: The effectiveness of a single 8-Gy fraction prophylactic cranial irradiation regime was assessed in 106 patients with small-cell carcinoma of the lung. All patients had limited stage disease and received combination chemotherapy consisting of either cisplatin or carboplatin with ifosfamide, etoposide, and vincristine (VICE). Cranial irradiation was administered 48 h after the first cycle of chemotherapy and was well tolerated. Actual 2-year survival was 35% and cranial relapse occurred in 22% of those patients who achieved complete remission. This compares favourably with a cranial relapse rate of 45% incomplete remitters previously reported with the same chemotherapy regime after a minimum follow-up of 2 years where PCI was not used. Formal psychometric testing was performed retrospectively on a series of 25 long-term survivors of whom 14 were taken from this reported series. Whilst 75% of patients were impaired on at least one test with 68% performing badly in the most complex task, this was not associated with clinically detectable neurological damage and the patients did not complain of memory or concentration difficulties. In conclusion, single fraction PCI, when used with platinum based combination chemotherapy, appears to be equally effective but may be less neurotoxic than the more standard fractionated regimes.
authors.affiliation: Department of Radiotherapy, Christie Hospital, Manchester, UK.
authors.forename: A E
authors.initials: AE
authors.lastname: Brewster
authors.forename: P
authors.initials: P
authors.lastname: Hopwood
authors.forename: R
authors.initials: R
authors.lastname: Stout
authors.forename: P A
authors.initials: PA
authors.lastname: Burt
authors.forename: N
authors.initials: N
authors.lastname: Thatcher
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000517:prevention & control* / Q000556:secondary; D016190:Carboplatin / Q000008:administration & dosage; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary; D002945:Cisplatin / Q000008:administration & dosage; D003071:Cognition / Q000187:drug effects / Q000528:radiation effects; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008175:Lung Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D008297:Male; D008568:Memory / Q000187:drug effects / Q000528:radiation effects; D011597:Psychomotor Performance / Q000187:drug effects / Q000528:radiation effects; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D005047:Etoposide; D016190:Carboplatin; D002945:Cisplatin; D007069:Ifosfamide