Cranial RT encouraged for lung cancer patients

Sep 14, 2010

Prophylactic cranial radiation therapy (RT) can increase the odds of survival for patients with limited-stage small cell lung carcinoma, but these patients often decline the treatment due to concerns about potential toxicities, according to a new study published online in Cancer.

At a Toronto hospital where almost 40% of eligible patients declined the treatment over a 10-year period, oncologists and radiation oncologists are suggesting that patients should receive more in-depth counseling and information about the risks and side effects of toxicities that may occur with RT techniques. Appropriately counseled, more patients, especially older ones, may opt to receive treatment that can prevent brain metastasis and extend their lives, according to the researchers (Cancer, August 27, 2010).

The study was conducted to determine the use of prophylactic cranial irradiation for patients with limited-stage small cell lung carcinoma at Princess Margaret Hospital between 1997 and 2007. Results revealed that of the 207 patients eligible, only 61.4% received the treatment.

The only patients not offered prophylactic cranial irradiation were those who had developed progressive disease after receiving an initial treatment of thoracic RT and chemotherapy, according to lead author Meredith Giuliani and colleagues from the department of radiation oncology. This represented an additional 21 patients. The eligible patients who accepted treatment received 2,500 cGy in 10 fractions, although some participating in clinical trials had different doses and fractionation schedules.

The length of survival increased significantly for patients who received the treatment. Three years following treatment, 40.1% were still alive, compared with 16% of the group who did not receive treatment. Among the patients alive at three years, 23.4% of the treatment group had developed brain metastases, compared with 53.3% of the nontreatment group.

Five years after treatment, 28.7% of the treatment group were alive, compared with 10% of the nontreatment group.

Thirty (37.5%) of the 80 patients who did not receive prophylactic cranial irradiation specifically refused the treatment. Fifteen patients (18.8%) were lost to follow-up. Among the 80 patients, 63.7% were older than 65.

Cranial irradiation decreases brain metastases, June 2, 2009

Quality of life suffers with cranial radiation to prevent lung cancer metastases, December 10, 2008

Prophylactic cranial irradiation reduces brain metastases from extensive lung cancer, August 16, 2007