title: Prophylactic cranial irradiation in operable stage IIIA non small-cell lung cancer treated with neoadjuvant chemoradiotherapy: results from a German multicenter randomized trial.
abstract: OBJECTIVE
  To investigate the role of prophylactic cranial irradiation (PCI) within a trimodality protocol (chemotherapy, chemoradiotherapy, surgery) for patients with operable stage IIIA non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  After mediastinoscopic staging, patients with operable stage IIIA NSCLC were enrolled to a German multicenter trial and randomly assigned to receive either primary resection followed by adjuvant thoracic radiation therapy (50 to 60 Gy; arm A) or preoperative chemotherapy (cisplatin/etoposide [PE]; three cycles) followed by concurrent chemoradiotherapy (PE plus 45 Gy; 1.5 Gy twice per day) and definitive surgery (arm B), respectively. Patients in arm B were scheduled to receive PCI (30 Gy; 2 Gy daily fractions).
  
  
  RESULTS
  One hundred twelve patients were randomly assigned between November 1994 and July 2001. One hundred six patients were eligible (arm A: 51, arm B: 55), 90 males and 16 females, 50 with squamous cell, 16 with large cell, five with adenosquamous, and 35 with adenocarcenoma (median age, 57 years; range, 37 to 71 years). Forty-three patients received PCI as scheduled in arm B. Eleven long-term survivors (arm A: four; arm B: seven) underwent a comprehensive neuropsychological examination. PCI significantly reduced the probability of brain metastases as first site of failure (7.8% at 5 years v 34.7%; P = .02), the overall brain relapse rate was reduced comparably (9.1% at 5 years v 27.2%; P = .04). A slightly reduced neurocognitive performance in comparison with the age-matched normal population was found for patients in both treatment groups. No significant difference between patients who were treated with or without PCI could be noted.
  
  
  CONCLUSIONS
  PCI is effective in preventing brain metastases following this aggressive trimodality approach. Neurocognitive late effects are not significantly different between patients treated with or without PCI.
authors.affiliation: Department of Radiotherapy, Institute for Biomathematics and Statistics, University of Duisburg-Essen, Essen, Germany. christoph.poettgen@uk-essen.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Pöttgen
authors.forename: Wilfried
authors.initials: W
authors.lastname: Eberhardt
authors.forename: Andreas
authors.initials: A
authors.lastname: Grannass
authors.forename: Soenke
authors.initials: S
authors.lastname: Korfee
authors.forename: Georg
authors.initials: G
authors.lastname: Stüben
authors.forename: Helmut
authors.initials: H
authors.lastname: Teschler
authors.forename: Georgios
authors.initials: G
authors.lastname: Stamatis
authors.forename: Horst
authors.initials: H
authors.lastname: Wagner
authors.forename: Bernward
authors.initials: B
authors.lastname: Passlick
authors.forename: Volker
authors.initials: V
authors.lastname: Petersen
authors.forename: Volker
authors.initials: V
authors.lastname: Budach
authors.forename: Hans
authors.initials: H
authors.lastname: Wilhelm
authors.forename: Isabel
authors.initials: I
authors.lastname: Wanke
authors.forename: Herbert
authors.initials: H
authors.lastname: Hirche
authors.forename: Hans-Jochen
authors.initials: HJ
authors.lastname: Wilke
authors.forename: Martin
authors.initials: M
authors.lastname: Stuschke
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000517:prevention & control* / Q000532:radiotherapy / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy* / Q000556:secondary / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005858:Germany; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy