Prophylactic cranial irradiationProphylactic cranial irradiation after definitive chemoradiotherapy for limited-stage small cell lung cancer: Do all patients benefit?

PurposeProphylactic cranial irradiation (PCI) can improve overall survival (OS) and suppress brain metastases (BM) in patients with limited-stage small cell lung cancer (LS-SCLC) after complete response to primary therapy. However, PCI can be toxic. We sought to identify characteristics of patients who may not benefit from PCI.MethodsWe identified 658 patients who received chemoradiotherapy at MD Anderson in 1986-2012; 364 received PCI and 294 did not. Median follow-up time was 21.2 months (range 1.2-240.8 months). Cox proportional hazards regression, competing-risk regression, and Kaplan-Meier analyses were used to identify factors influencing OS and BM.ResultsPCI reduced risks of death [HR 0.73, 95% CI 0.61-0.88, P = 0.001] and BM [HR 0.54, 95% CI 0.39-0.76, P < 0.001]. Having tumors ⩾5 cm increased the risk of BM [HR 1.77, 95% CI 1.22-2.55, P = 0.002] but not death [HR 1.16, 95% CI 0.96-1.40, P = 0.114]. Among patients ⩾70 years with ⩾5-cm tumors, PCI did not improve OS [2-year rates 39.4% vs 40.9%, P = 0.739].ConclusionsPCI remains standard therapy after complete response to chemoradiotherapy for LS-SCLC. However, older patients may be at risk from comorbidity or extracranial disease. Further work is warranted to identify patients who may not benefit from PCI.