title: Nine-year Experience: Prophylactic Cranial Irradiation in Extensive Disease Small-cell Lung Cancer.
abstract: In 2007, the European Organization for Research and Treatment of Cancer (EORTC) study (ClinicalTrials.gov identifier, NCT00016211) demonstrated a beneficial effect on overall survival (OS) with the use of prophylactic cranial irradiation (PCI) for extensive disease (ED) small-cell lung cancer (SCLC). Nevertheless, debate is ongoing regarding the role of PCI, because the patients in that trial did not undergo magnetic resonance imaging (MRI) of the brain before treatment. Also, a recent Japanese randomized trial showed a detrimental effect of PCI on OS in patients with negative pretreatment brain MRI findings.
  
  
  
  We examined the medical records of 136 patients with ED SCLC who had initially responded to chemotherapy and undergone PCI from 2007 to 2015. The outcomes, radiation toxicity, neurologic progression-free survival, and OS after PCI were analyzed. Survival and correlations were calculated using log-rank and univariate Cox proportional hazard ratio analyses.
  
  
  
  The median OS and the median neurologic progression-free survival after PCI was 12 and 19 months, respectively. No significant survival difference was seen for patients who had undergone MRI before PCI compared with patients who had undergone contrast-enhanced computed tomography (P = .20). Univariate analysis for OS did not show a statistically significant effect for known cofactors.
  
  
  
  In the present cohort, PCI was associated with improved survival compared with the PCI arm of the EORTC trial, with a nearly doubled median OS period. Also, the median OS was prolonged by 2 months compared with the irradiation arm of the Japanese trial.
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany. Electronic address: denise.bernhardt@med.uni-heidelberg.de.
authors.forename: Denise
authors.initials: D
authors.lastname: Bernhardt
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Adeberg
authors.affiliation: Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg Translational Lung Research Centre, Heidelberg, Germany; German Centre for Lung Research, Heidelberg, Germany.
authors.forename: Farastuk
authors.initials: F
authors.lastname: Bozorgmehr
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Opfermann
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Hoerner-Rieber
authors.affiliation: Department of Radiation Medicine, Georgetown University Hospital, Washington, DC.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Repka
authors.affiliation: Department of Pneumology, Thoraxklinik, Heidelberg University, Heidelberg, Germany.
authors.forename: Jutta
authors.initials: J
authors.lastname: Kappes
authors.affiliation: Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg Translational Lung Research Centre, Heidelberg, Germany; German Centre for Lung Research, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg Translational Lung Research Centre, Heidelberg, Germany; German Centre for Lung Research, Heidelberg, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Bischoff
authors.affiliation: German Centre for Lung Research, Heidelberg, Germany; Department of Pneumology, Thoraxklinik, Heidelberg University, Heidelberg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Herth
authors.affiliation: German Centre for Lung Research, Heidelberg, Germany; Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Heußel
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.affiliation: Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg Translational Lung Research Centre, Heidelberg, Germany; German Centre for Lung Research, Heidelberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Steins
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rieken
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000517:prevention & control* / Q000556:secondary; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055752:Small Cell Lung Carcinoma / Q000401:mortality / Q000517:prevention & control* / Q000556:secondary; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Brain metastasis; ED; PCI; SCLC; Survival