EFFICACY AND SAFETY OF PROPHYLACTIC CRANIAL IRRADIATION IN PATIENTS WITH SMALL-CELL LUNG-CANCER

Background: Prophylactic cranial irradiation (PCI) as part of the trea ment regimen for patients with limited stage small cell lung cancer (S CLC) remains controversial. The present study was performed to analyze the efficacy and safety of PCI in patients with limited stage SCLC wh o achieved complete remission. Patients and methods: Between 1983 anti 1993, thirty-nine patients with limited stage SCLC who had shown comp lete remission after chemotherapy were enrolled prospectively into the non-randomized study. Eighteen of them received PCI (PCI+), while 21 did not (PCI-). Pretreatment CT or MRI of the brain was performed in a ll patients. Patients were prospectively evaluated by a neurologist at regular intervals. Results: Three PCI+ patients and seven PCI- patien ts developed brain metastases. The frequencies of brain metastases wer e not significantly different between the groups (Fisher's exact test, p = 0.207), but brain metastases in PCI+ patients tended to occur lat er (log rank, p = 0.008). Overall survival was significantly longer in PCI+ patients (log rank, p < 0.001). Early toxicity consisted of head ache, nausea, fatigue, concentration problems and alopecia. These symp toms and signs were mild and usually reversible within a few months. L ate toxicity was studied in patients whose survival exceeded two years . Seven PCI+ patients survived for more than two years, while no PCI- patients survived for more than two years. Memory problems were seen i n six of the seven patients. These problems were non-disabling and, on ce established, remained stable for months to years. The most prominen t radiologic abnormalities were cortical atrophy and leuko encephalopa thy, found in four of the five patients who underwent radiologic follo w-up examination. Conclusions: This non-randomized study suggests that PCI may be effective by decreasing the frequency of brain metastases and by increasing the brain metastasis-free survival and overall survi val, with a minor risk of clinical and radiologic neurotoxicity.