Radiation to the Brain Should Become Standard Therapy for Extensive-Disease Small Cell Lung Cancer
Researchers affiliated with the EORTC Radiation Oncology Group and Lung Cancer Group have reported that prophylactic cranial radiation following treatment with chemotherapy should now become a standard treatment option for patients with extensive-disease small cell lung cancer (SCLC). The details of this randomized trial were published in the August 16, 2007 issue of the New England Journal of Medicine. This study had previously been presented at the 2007 meeting of the American Society of Clinical Oncology.
Prophylactic whole brain radiation is standard therapy for patients with limited stage SCLC but has not been considered standard therapy for patients with extensive stage SCLC.
The EORTC trial included 286 patients who demonstrated a response to four to six cycles of chemotherapy. Seventy percent of patients had disease that had spread outside the lung. Following chemotherapy, one group of patients received prophylactic cranial radiation, while the other group of patients did not receive cranial radiation.
- At one year, brain metastases that caused symptoms occurred in 14.6% of patients treated with cranial radiation compared with 40.4% of patients in the observation group.
- Survival was doubled at one year for patients treated with cranial radiation compared to those in the observation group (27.1% versus 13.3%, respectively).
- Radiation was generally well tolerated; the most common side effects were headache, nausea and vomiting, and fatigue.
Comments: These results indicate that prophylactic cranial radiation appears to significantly improve survival at one year and reduces the risk of developing brain metastasis among patients with extensive-disease SCLC who respond to chemotherapy. Furthermore, cranial radiation did not significantly reduce quality of life among these patients. The researchers concluded: “Prophylactic cranial irradiation should be part of standard care for all patients with small-cell lung cancer who have a response to initial chemotherapy, and it should be part of the standard treatment in future studies involving these patients.”
Reference: Slotman B, Faivre-Finn C, Krameractic G, et al. Prophylactic cranial irradiation in extensive small-cell lung cancer. New England Journal of Medicine. 2007; 357:664-672.
Related News:Prophylactic Cranial Radiation Improves Survival in Extensive Small-Cell Lung Cancer (6/5/2007)
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