SINGLE FRACTION PROPHYLACTIC CRANIAL IRRADIATION FOR SMALL-CELL CARCINOMA OF THE LUNG

The effectiveness of a single 8-Gy fraction prophylactic cranial irrad iation regime was assessed in 106 patients with small-cell carcinoma o f the lung. All patients had limited stage disease and received combin ation chemotherapy consisting of either cisplatin or carboplatin with ifosfamide, etoposide, and vincristine (VICE). Cranial irradiation was administered 48 h after the first cycle of chemotherapy and was well tolerated. Actual 2-year survival was 35% and cranial relapse occurred in 22% of those patients who achieved complete remission. This compar es favourably with a cranial relapse rate of 45% incomplete remitters previously reported with the same chemotherapy regime after a minimum follow-up of 2 years where PCI was not used. Formal psychometric testi ng was performed retrospectively on a series of 25 long-term survivors of whom 14 were taken from this reported series. Whilst 75% of patien ts were impaired on at least one test with 68% performing badly in the most complex task, this was not associated with clinically detectable neurological damage and the patients did not complain of memory or co ncentration difficulties. In conclusion, single fraction PCI, when use d with platinum based combination chemotherapy, appears to be equally effective but may be less neurotoxic than the more standard fractionat ed regimes.