Prophylactic Cranial Irradiation in Small Cell Lung Cancer Increases Survival

Most patients with SCLC present with extensive disease (ED) at diagnosis, meaning that the cancer has metastasized to other areas of the body. Without treatment, consisting of chemotherapy, the average survival is two to four months. In spite of treatment, in most patients, disease progression will lead to death within one year. The spread of cancer to the brain is a major cause of death and has a profound negative effect on psychologic and physical functioning.

Studies conducted mostly in the 1980 had shown that for patients with limited SCLC and complete response to chemotherapy, prophylactic brain irradiation decreased the risk of brain metastasis and improved survival.

In the European Organization for Research and Treatment of Cancer (EORTC; Brussels, Belgium) study, published in the August 16, 2007, issue of the New England Journal of Medicine, Ben Slotman, M.D., Ph.D., professor of radiation oncology at the VU University Medical Center (VUMC; Amsterdam, The Netherlands) 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 SCLC. Two-hundred-and-eighty-six 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.

One year after being randomized in the trial, only 14.4 % of the patients that received PCI suffered from symptomatic metastasis 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.

"Prophylactic cranial irradiation significantly reduces the risk of symptomatic brain metastases and significantly prolongs survival,” according to Prof. Slotman. "As this treatment is well tolerated and does not adversely influence quality of life, prophylactic cranial irradiation should now routinely be offered to all SCLC patients with extensive disease whose cancer responds to chemotherapy.”

For Roy S. Herbst, M.D., Ph.D., professor of medicine in the department of thoracic/head and neck medical oncology, University of Texas/Section Chief of Thoracic Medical oncology at the MD Anderson Cancer Center (Houston, TX, USA), the findings of this study represented the most significant clinical finding for the treatment of patients with lung cancer.

Furthermore, the trial results give credence to the further research hypothesis that thoracic radiotherapy--using the current advanced radiotherapy techniques--might be beneficial to this pretreated patient group as well--a theory Prof. Ben Slotman and colleagues are preparing to evaluate in a clinical randomized trial to run in The Netherlands, the United Kingdom, and possibly more European countries.


Related Links:
VU University Medical Center
EORTC