Low-dose prophylactic cranial irradiation in patients with poor prognosis small-cell lung cancer.
OBJECTIVE
In small-cell lung cancer (SCLC), prophylactic cranial irradiation (PCI) provides a survival advantage in good performance status patients with limited disease. Its role in those with poor performance status limited disease or extensive disease is unclear. A low-dose PCI schedule has been used in these groups, and outcomes have been analysed.


METHODS
Retrospective analyses of brain metastasis-free survival and overall survival of patients receiving low-dose PCI over a 2-year period.


RESULTS
Fifty-six patients were treated, with 55 evaluable due to missing notes for one. No major treatment-related toxicity was observed. Median brain metastasis-free survival and overall survival for the group were 44 and 46 weeks, respectively. The median brain metastasis-free survival were 32 and 50 weeks, and median overall survival were 39 and 57 weeks, in those with extensive and limited disease, respectively. A total of 10 patients developed clinical or radiological evidence of brain metastases, four (16%) with limited disease and six (21%) with extensive disease. Thirteen (52%) with limited disease and 10 (36%) with extensive disease survived 1 year.


CONCLUSIONS
Symptomatic brain metastases occurred less frequently than would be expected, with most patients developing widespread metastatic disease. Low-dose PCI may benefit these groups, and the results of an ongoing EORTC randomised-controlled trial in extensive disease should provide more information.
Henry
A M
AM
Cookridge Hospital, West Yorkshire, UK. amhenry@doctors.net.uk
Snee
M P
MP
D000368:Aged; D001932:Brain Neoplasms / Q000517:prevention & control* / Q000556:secondary; D018288:Carcinoma, Small Cell / Q000532:radiotherapy* / Q000556:secondary; D016371:Cranial Irradiation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011879:Radiotherapy Dosage; D016019:Survival Analysis