VALUE OF PROPHYLACTIC CRANIAL IRRADIATION GIVEN AT COMPLETE REMISSION IN SMALL CELL LUNG-CARCINOMA

  • 1 January 1983
    • journal article
    • research article
    • Vol. 67  (7-8) , 675-682
Abstract
The optimal use of prophylactic cranial irradiation (PCI) in patients with small cell lung cancer remains undetermined. The impact is reviewed of PCI, given at complete remission (CR), on neurologic relapse in 172 consecutive patients with small cell lung cancer treated in 3 sequential chemotherapy protocols. In the 1st study of 38 patients, none received PCI. In the 2nd study of 109 patients, the first 28 achieving CR were randomized to 3000 rad of PCI in 10 fractions (PCI+) or to observation (PCI-). Thereafter, based on interim analysis, all patients achieving CR received PCI. In the 3rd study, to date, 25 patients achieving CR have received PCI. Overall, 169 patients were evaluable for neurologic relapse, and 30 of 90 patients achieving CR received PCI. Among all patients with CR, with adjustment for disease extent, there was a significant delay to any neurologic relapse (P = 0.01) and cerebral metastases (P = 0.02) for PCI+ compared to PCI- patients. Among PCI- patients with CR, cerebral metastases alone occurred in 28% as the sole site and in 33% as the initial site; cerebral relapse occurred prior to systemic relapse in only 1 PCI+ patient with CR. Patient survival was not significantly altered by PCI. PCI at CR confers effective and worthwhile local control in the CNS, especially during periods of systemic response, and a small percentage of patients may benefit. Systemic drug resistance still determines overall survival.