Prophylactic cranial irradiation in patients with small-cell lung cancer

Abstract

32.5 Conclusions: The meta-analysis performed by the Prophylactic Cranial Irradiation Overview Collaborative Group has provided clear evidence of the beneficial effects of this treatment in terms of survival and reduction of cerebral metastasis. Delivery of PCI results in a 5.4% improvement in overall survival at 3 years after the commencement of induction chemotherapy. PCI was also shown to yield a 54% proportional reduction in the incidence of cerebral metastases, from 59% to 33%, at 3 years. Subgroup analysis suggests a trend toward reduced incidence of cerebral metastasis with increased radiation dose and earlier introduction of PCI into the treatment regimen. Further studies will address the effect of different radiation doses and fractionation regimens (including twice-daily, hyperfractionated radiotherapy) and the optimal timing of PCI relative to induction chemotherapy. Evaluation of the data on the neuropsychiatric sequelae of PCI suggest that patients have significant abnormalities at baseline and that there is no demonstrable change after PCI. However, there is a suggestion that PCI delivered concomitantly with chemotherapy may be associated with a significant deterioration in cognitive function. © 2006 Springer Berlin Heidelberg.