Prophylactic cranial irradiation in limited-stage small-cell lung cancer: a retrospective analysis

It is well established that prophylactic cranial irradiation (PCI) decreases significantly the incidence of brain metastases (BM) and increases overall survival in limited-stage small-cell lung cancer (LS-SCLC) patients with complete response to induction therapy. The aim of this study was to complete a review analysis of PCI use among patients diagnosed with LS-SCLC in a community hospital.

A retrospective review of medical charts of patients diagnosed with LS-SCLC between January 1997 and December 2002 at a local community hospital in Fargo, North Dakota, was done to determine which of these patients subsequently received PCI. Data on patient's age, gender, body mass index at diagnosis, SCLC anatomical site, other comorbidies at diagnosis, treatment of SCLC, chemotherapeutic agents used at diagnosis of SCLC, response to induction treatment, PCI use, reason(s) for no PCI, BM status, BM site, metastases to other sites, and survival were abstracted.

A total of 32 patients with LS-SCLC were identified. Twenty-three (71.9%) of the patients received concurrent chemotherapy and radiation therapy. Of the remaining 9 (28.1%) patients, 6 (18.7%) did not receive any treatment because of poor performance status, and 3 (9.4%) received only chemotherapy because of coexisting comorbidity. Thirteen (40.6%) of the patients achieved a complete response but only 4 (30.8%) patients had PCI. Among the 9 (69.2%) patients who appeared eligible to receive PCI, 1 (11.2%) refused, 4 (44.4%) had coexisting comorbidities, and 4 (44.4%) had no notes indicating why they did not receive PCI. Of those who had PCI, only 1 (25%) patient developed BM 35 months later.

This review found that although only a few patients were eligible to receive PCI, nevertheless, the benefits could be significant. We concluded that oncologists should be more willing to offer this procedure.