Cranial irradiation in small cell lung cancer increases survival
Lung Cancer Treatment
Prophylactic cranial irradiation after chemotherapy significantly reduces the risk of brain metastasis and doubles one-year survival in small-cell lung cancer (SCLC), according to the results of the multicenter phase III randomized EORTC trial 08993-22993, published in the New England Journal of Medicine today.
Small cell lung cancer (SCLC) is an aggressive tumor that constitutes nearly 15% of all newly diagnosed lung cancers. The majority of patients with SCLC present with extensive disease (ED) at diagnosis, meaning that the cancer has spread to other areas of the body. Without treatment, consisting of chemotherapy, the median survival is two to four months. Despite treatment, in most patients, disease progression will lead to dead within one year. Cancer spreading to the brain is an important cause of death and has a profound negative effect on psychological and physical functioning.
Studies conducted primarily in the 1980 had shown that for patients with limited SCLC and complete response to chemotherapy, prophylactic brain irradiation reduced the risk of brain metastasis and improved survival.
In the EORTC 08993-22993 study, Ben Slotman, MD, PhD, Professor of Radiation Oncology at the VU University medical center in Amsterdam, and his European colleagues from the EORTC Radiation Oncology and Lung Cancer Groups extended the use of prophylactic cranial irradiation (PCI) to patients with extensive small cell lung cancer. 286 patients were randomized to either receive prophylactic irradiation or to being observed, following four to six cycles of chemotherapy that induced a response of their SCLC.
Results of the study
One year after being randomized in the trial, only 14.4 % of the patients that received PCI suffered from symptomatic spread of their cancer to the brain, compared with 40.4 % of the patients who did not receive PCI. Moreover, 27.1% of the patients receiving PCI were alive after one year, compared with 13.3% of the patients who were not prophylactically irradiated.
Why this study is important: