According to results recently presented at the ASCO annual meeting, prophylactic cranial radiation following treatment with chemotherapy doubles survival at 1 year and reduces the risk of developing brain metastases among patients with extensive-disease small-cell lung cancer (SCLC).

About 70 percent of SCLC patients have disease that has already spread extensively at the time of their diagnosis, and a significant number of patients develop brain metastases. Previous studies have shown that prophylactic cranial irradiation (PCI) prevents brain metastases and improves survival in SCLC patients who have local disease and a complete response to initial chemotherapy. New results presented at the ASCO meeting indicate that this strategy remains sound, even when SCLC has spread extensively.

Findings were presented by lead author Dr. Ben Slotman of the VU University Medical Center in Amsterdam. The trial randomized 286 patients who had responded to 4 to 6 cycles of chemotherapy to observation or PCI consisting of 20 to 30 Gy administered in 5 to 12 fractions. At 1 year, symptomatic brain metastases occurred in 14.6 percent of patients treated with cranial radiation compared with 40.4 percent of patients in the observation group. Survival was doubled at 1 year for patients treated with cranial radiation compared with those in the observation group (27.1 versus 13.3 percent, respectively). Radiation was well tolerated and the most common side effects were headache, nausea and vomiting, and fatigue.