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Utilization of prophylactic cranial irradiation in patients with limited stage small cell lung carcinoma
Meredith Giuliani1, Alexander Sun, Andrea Bezjak
1Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Background:
This study reports the adoption of prophylactic cranial irradiation (PCI) in patients with limited stage small cell lung carcinoma (LS-SCLC) at Princess Margaret Hospital (PMH) and the factors that impact PCI utilization.
Methods:
A retrospective review was performed on all patients with LS-SCLC treated at PMH from 1997 to 2007. Clinical details including the rate of PCI utilization were determined and, for patients not receiving PCI, the documented reason was recorded. Brain failure free survival (FFS) and overall survival (OS) were estimated by the Kaplan-Meier method, comparing patients treated with or without PCI. Pearson chi-square test was used to determine factors associated with PCI use.
Results:
Two hundred seven patients were treated for LS-SCLC and 61.4% (n = 127) of these patients received PCI. The most common documented reason for not receiving PCI was patient refusal, typically because of concerns about PCI toxicity. Patients older than 65 were significantly less likely to receive PCI. Brain FFS and OS rates were significantly higher in patients who received PCI.
Conclusions:
Not all eligible patients are receiving PCI, despite its significant effect on reducing brain metastases and improving OS. Emphasizing the benefits of PCI to patients, when discussing potential toxicities, may improve utilization.