Prophylactic Cranial Irradiation for Patients With Small-Cell Lung Cancer in Complete Remission

Background: Prophylactic cranial irradiation in patients with small-cell lung cancer decreases the overall rate of brain metastases without an effect on overall survival. It has been suggested that this treatment may increase neuro-psychological syndromes and brain abnormalities indicated by compute...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute 1995-02, Vol.87 (3), p.183-190
Main Authors: Arriagada, Rodrigo, Le Chevalier, Thierry, Borie, Fangoise, Riviere, Alain, Chomy, Pierre, Monnet, Isabelle, Tardivon, Anne, Viader, Fausto, Tarayre, Michele, Benhamou, Simone
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Brain
Brain Neoplasms - prevention & control
Brain Neoplasms - secondary
Carcinoma, Small Cell - prevention & control
Carcinoma, Small Cell - secondary
Clinical trials
Cranial Irradiation - adverse effects
Disease-Free Survival
Female
Humans
Lung cancer
Lung Neoplasms - pathology
Male
Medical sciences
Middle Aged
Pneumology
Prospective Studies
Radiation
Radiotherapy Dosage
Remission Induction
Survival Analysis
Treatment Outcome
Tumors of the respiratory system and mediastinum
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Summary:Background: Prophylactic cranial irradiation in patients with small-cell lung cancer decreases the overall rate of brain metastases without an effect on overall survival. It has been suggested that this treatment may increase neuro-psychological syndromes and brain abnormalities indicated by computed tomography scans. However, other retrospective data suggested a beneficial effect on overall survival for patients in complete remission. Purpose: Our purpose was to evaluate the effects of prophylactic cranial irradiation on brain metastasis, overall survival, and late-occurring toxic effects in patients with small-cell lung cancer in complete remission. Methods: We conducted a prospective study of 300 patients who had small-cell lung cancer that was in complete remission. The patients were randomly assigned to receive either prophylactic cranial irradiation delivering 24 Gy in eight fractions during 12 days (treatment group) or no prophylactic cranial irradiation (control group). A neuro-psychological examination and a computed tomography scan of the brain were performed at the time of random assignment and repeatedly assessed at 6, 18, 30, and 48 months. Patterns of failure were analyzed according to total event rates and also according to an isolated first site of relapse, using a competing-risk approach. Results: Two hundred ninety-four patients who did not have brain metastases at the time of random assignment were analyzed. The 2-year cumulative rate of brain metastasis as an isolated first site of relapse was 45% in the control group and 19% in the treatment group (P
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/87.3.183