M. Vandepol et al., EFFICACY AND SAFETY OF PROPHYLACTIC CRANIAL IRRADIATION IN PATIENTS WITH SMALL-CELL LUNG-CANCER, Journal of neuro-oncology, 35(2), 1997, pp. 153-160
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.