Prophylactic cranial irradiation for small-cell lung cancer: long-term results

Over a six-year period, 72 patients with small-cell lung cancer received prophylactic cranial irradiation, as well as combination chemotherapy. There were 58 patients with limited-stage disease. With a minimum of four years follow-up, there are only four survivors, one of whom is affected by a crippling treatment-induced neurological deficit, and another has moderate impairment of cognitive functions. Despite cranial prophylaxis, 14 patients died from cerebral metastases, and four others of undiagnosed neurological problems. One other patient, who died apparently in remission, also had severe iatrogenic brain damage. These results cast doubt upon the value of this form of treatment in a disease that remains incurable for the vast majority of sufferers.