158 Prophylactic cranial irradiation in lung cancer: a single institution experience

Abstract

Introduction: Prophylactic cranial irradiation (PCI) is a treatment modality used to prevent the development of brain metastases in small cell lung carcinoma. Randomized phase III studies have demonstrated an overall survival benefit in limited and extensive stage disease. The aim of this study was to analyze the incidence of symptomatic brain metastases, overall survival and progression-free survival after PCI, in a single institution over a five year period. Method: We conducted a retrospective search of all patients who had received PCI between October 2006 and October 2011 at the Whitfield Clinic, the radiation oncology facility linked to our institution. Patient and disease-related characteristics, the subsequent development of brain metastases, progression-free survival, and overall survival data was collected. Results: 24 patients received PCI in a 5 year period in our institution. 58.3% of patients were male and 41.7% were female, with a mean age of 62.5 years (range 31 78) and a standard deviation of 9.96. All patients were smokers. 50% of patients had limited stage small cell lung cancer and 50% had extensive stage small cell lung cancer. No patients with extrapulmonary small cell carcinoma or non-small cell lung cancer received PCI. 8.2% of the patients developed brain metastases post PCI (p = 0.478.) The median PFS for limited stage disease was 13 months (range 3 20) and 10 months (range 5 18) for extensive stage disease. Median OS was 15 months (range 4 29) for limited stage disease and 11 months (range 5 29) for extensive stage disease. Conclusions: PCI is a treatment modality used in limited and extensive stage small cell lung carcinoma. Our study demonstrated a reduced incidence of symptomatic brain metastases and an improvement in median PFS and median OS, in keeping with published phase III data. PCI in non-small cell lung cancer and extrapulmonary small cell carcinoma remains controversial.